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MAY 2009

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    MAY 2009 MAY 2009 Document Transcript

    • MERSEY DEANERY LAT Locum for Training( higher surgical training) IN GENERAL SURGERY JOB DESCRIPTION MAY 2009 F JD/GEN SURG.SPR April 2005 1
    • CONTENTS ALL SPECIALIST REGISTRAR POSTS IN GENERAL SURGERY IN THE MERSEY REGION 4 LAT positions are available 2 at Aintree, 1 at countess of chester, 1 at Royal TRUST CONSULTANT SPECIALTY LEVEL OF TRAINING P Skaife AINTREE 1 J Arthur Lower GI/Colorectal General Subspecialty S Fenwick AINTREE 2 H Malik Liver surgery General subspecialty L Martin AINTREE 3 R Hardy Breast/Endocrine General subspecialty R Ward J Joseph AINTREE 4 F Torella Vascular General subspecialty R Ward J Joseph AINTREE 5 F Torella Vascular General subspecialty R Macadam AINTREE 6 I Khan Upper GI General subspecialty C Barben S Slavik Lower GI/ AINTREE 7 Colorectal General Subspecialty M Shotri Upper GI/ AINTREE 8 I Khan Laparoscopic General Subspecialty G Poston AINTREE 9 P Ghaneh Liver surgery General Subspecialty L de Cossart P Edwards COUNTESS OF CHESTER 1 S Dimitri Vascular General subspecialty G Foster COUNTESS OF CHESTER 2 M Johnson Lower GI/LAP General subspecialty D Monk COUNTESS OF CHESTER 3 J Evans Upper GI/Lower General subspecialty E Redmond COUNTESS OF CHESTER 4 C Harding-McKean Breast/ General General subspecialty COUNTESS OF CHESTER 5 L Decossart RESEARCH S Dimitri COUNTESS OF CHESTER 6 P Edwards Vascular/General General J Evans COUNTESS OF CHESTER 7 D Monk M Johnson COUNTESS OF CHESTER 8 G Foster S Shakar LEIGHTON 1 Khan Colorectal- Lap General A Guy LEIGHTON 2 M Hanafy Vascular General D Corless LEIGHTON 3 J Slavin Upper GI/HPB General M Hanafy LEIGHTON 4 A Guy Vascular/General General J Slavin LEIGHTON 5 D Corless UpperGI/HPB General LEIGHTON 6 Khan Colorectal General W Brough MACCLESFIELD 1 A Quayle LowerGI/General General C Rosenhall MACCLESFIELD 2 U Khan Breast/colorectal genral F JD/GEN SURG.SPR April 2005 2
    • P Moody NORTH CHESHIRE T Nicholas HOSPITALS 1 D Olojugba Vascular / General T Nicholas NORTH CHESHIRE P Moody HOSPITALS 2 Vascular / General NORTH CHESHIRE B Taylor HOSPITALS 3 M Tighe Colorectal NORTH CHESHIRE B Taylor HOSPITALS 4 M Tighe Colorectal NORTH CHESHIRE G Copeland HOSPITALS 5 J Lund Breast / General NORTH CHESHIRE HOSPITALS 6 M Brett Upper GI / General NORTH CHESHIRE HOSPITALS 7 A Razez Colorectal – Lap TRUST CONSULTANT SPECIALTY LEVEL OF TRAINING G Mitchell C Holcombe RLUH/BGN 1 M Chandrasekar Breast/ general General subspecialty P Rooney RLUH/BGN 2 R Heath Colorectal/General General subspecialty A Waghorn RLUH BGN 3 A Tansley Endoecrine/Breast/General General subspecialty R Vallabheneni RLUH BGN 4 J Brennan Vascular/Subspecialty General subspecialty A Bakran RLUG/BGN 5 G Gilling-Smith Vascular/General General RLUH BGN 6 P Carter Colorectal/General General subspecialty N Howes RLUH/BGN/CTC 7 M Hartley Upper GI General subspecialty J Neoptolemos R Sutton RLUH BGN 8 P Ghaneh Hepatobiliary/subspecialty General subspecialty RLUH/BGN 9 RESEARCH R Sutton Research on Programme J Neoptolemos RLUH/BGN 10 M Raraty Hepatobiliary/subspecialty General subspecialty RLUH/BGN 11 U Gur Colorectal General Subspecialty R fisher RLUH/BGN 12 J Brennan Vascular General Subspecialty M Hartley RLUH/BGN/CTC 13 N Howes Upper GI General Subspecialty A Bakran RLBUH 1 TRANSPLANT A Hammad SURGERY A J Sharma Transplant Surgery General subspecialty A Hammand RLBUH 2 TRANSPLANT A Bakran SURGERY 2 A J Sharma Transplant Surgrery General Subspecialty M Zeiderman SOUTHPORT 1 R Guneskhera Gastroenterology General Subspecialty F Mason SOUTHPORT 2 D Jones Vascular Surgery/General General Subspecialty SOUTHPORT 3 D Artiouk Breast/General General Subspecialty D Maitra WHISTON 1 R Kiff Lower GI/Laparoscopic General WHISTON 2 Vacant- locum Upper GI / General General Subspecialty L Chagla WHISTON 3 R Audisio Breast / General General R Kiff WHISTON 4 M Scott Colorectal/Laparoscopic General Subspecialty WHISTON 5 A Kaul Upper GI / General General S Blair WIRRAL 1 C Chan Vascular/General General C Makin C Walsh WIRRAL 2 J Anderson Colorectal/General General Subspecialty C Walsh J Anderson WIRRAL 3 C Makin Lower GI/ General General Subspecialty WIRRAL 4 M S Javid Upper GI/ General General F JD/GEN SURG.SPR April 2005 3
    • A Masters Pancreatico - Biliary D Berstock F Swe WIRRAL 5 M Callaghan Breast/General General Subspecialty M Chandrasekar WIRRAL 6 S Blair Vascular/General General Subspecialty A Masters WIRRAL 7 M S Javid Upper GI General Subspecialty J Anderson C Makin C Walsh WIRRAL 8 Colorectal/General General Subspecialty Titu WIRRAL 9 Javed Colorectal/ general General Subspecialty F JD/GEN SURG.SPR April 2005 4
    • Information: individual trusts AINTREE HOSPITAL AINTREE NHS TRUST UNIVERITY HOSPITAL AINTREE HOSPITAL AND AREA The Trust serves a population of approximately one third of a million from North Liverpool, Sefton Borough and Kirkby and is situated on two main hospital sites. All in-patient services and some out-patient services are provided from the University Hospital Aintree, which is located in Fazakerley, and some out-patient services and day case surgery are provided from the Walton Hospital site. The University Hospital Aintree is a large teaching hospital for the University of Liverpool with a total in-patient bed complement of 965. It houses a large Accident and Emergency Department and most major acute specialties are represented including General Surgery, Orthopaedics, Urology and acute medical services. In addition, there are specialised units for Cardiology, Thoracic Medicine, Diabetes, Rheumatology and Rehabilitation, Gastroenterology, Medicine for the Elderly and the Younger Disabled Unit. There is a fully equipped 9 bed General Intensive Care Unit, an 8 bed High Dependency unit and a large Cardiac Intensive Care Unit, as well as a dedicated acute Stroke Unit. It is also the site of the sub-Regional Public Health Laboratory and there is a large Radiology Department servicing the hospital. A new Diagnostic and Treatment Centre to replace the facilities currently at Walton is planned for the Aintree site. Walton Hospital is situated approximately 4 miles from the city centre and 2 1/2 miles from the University Hospital Aintree, providing out-patient and day case services (48 beds). The Ophthalmology Directorate is based on this site. STUDY AND TRAINING All posts are recognised for Postgraduate Training. Aintree Hospitals are entering a period of reorganisation and during his/her tenure at the hospital, the postholder will be expected to adopt a flexible attitude to changes in duties consequent upon any changes in the distribution of services agreed by the Clinical Director. Arrangements to visit may be made with: Mr G Poston Mr R Macadam college tutor Clinical Director General Surgery Consultant Surgeon Aintree Hospitals NHS Trust Aintree Hospitals NHS Trust University Hospital Aintree University Hospital Aintree Lower Lane Lower Lane Liverpool Liverpool L9 7AL L9 7AL Tel: 0151-529-2769 Tel: 0151-529-4950 F JD/GEN SURG.SPR April 2005 5
    • COUNTESS OF CHESTER NHS TRUST Countess of Chester Hospital HOSPITAL AND AREA The Specialist Registrar will work within Chester Health Authority’s Surgical Division which comprises the new Countess of Chester Hospital, (120 Surgical Beds). The Countess of Chester Hospital was opened in January 1983 and built to the Anucleus Design≅. Its bed complement is made up of 138 for General Surgery, ENT, Traumatology, OMFU, Ophthalmology, Plastic Surgery and includes 21 Child Surgery beds. The hospital also contains the District’s Accident and Emergency Department, ITU, Day Surgery Ward and 9 Operating Theatres together with a 6 bed High Dependency Unit for surgical cases. The Postgraduate Medical Centre is in the grounds of the Countess of Chester Hospital, where a full Postgraduate programme is available. The successful candidate is entitled to avail himself of the facilities which includes the Medical Library which is open until 9.00 pm most weekdays. A full range of journals and text books are kept within this Library and there is a Silver Platter Medline Service for reference retrieval and reprint service. ACTIVITY The General Surgical Unit is extremely busy. It is able to train at sub-specialty level in Gastroenterology, Breast and Vascular Surgery and all types of Gastrointestinal Endoscopy. Laparoscopic cholecystectomy is a standard method of treatment in this hospital and a ND YAG laser is employed in the palliative treatment of both oesophageal and rectal tumours. Investigative procedures of the Upper GI Tract are full and include 24 hour Oesophageal PH monitoring. The Radiology Department provides a full range of investigative procedures including CT scanning, MRI scanning, diagnostic and interventional ultrasound scanning, DVI, angiography and percutaneous transluminal angioplasty service, colour flow duplex. In addition as there is a dedicated breast screening service. The Vascular Unit has a vascular laboratory and a full time vascular technician. A large number of emergencies are dealt with enabling the holder of the post to acquire excellent experience in this field. There is an involvement in the teaching of Medical Students whether elective or seconded by their University Medical Schools. Specialist Registrar attachments are from Liverpool, Manchester and Nottingham. TUTORIALS AND MEETINGS Seminars for the members of the General Surgical Department are held weekly and there are full opportunities for clinical research projects. Computerised Audit is carried out in this hospital with fortnightly Morbidity/Mortality Meetings and a full Audit Meeting once a month. In addition there are Surgico-pathological and Surgico-radiological meetings. All members of the Surgical Department are full members of the Surgical Directorate. The hospital has now developed a rotating half-day which occurs at fortnightly intervals. All departments close down and the resulting time is devoted to Postgraduate Education Seminars and Tutorials. Clinical research projects are actively encouraged. ACCOMMODATION It is hoped that it will be possible to offer either married or single accommodation. An on- call room and mess facilities are provided at the Countess of Chester Hospital. CONTACTS Ms S M Bennett Mr D Monk Personnel Services Specialty Tutor Countess of Chester NHS Trust Countess of Chester NHS Trust Liverpool Road Liverpool Road F JD/GEN SURG.SPR April 2005 6
    • Chester Chester CH2 1BQ CH2 1BQ Tel: 01244 365 000 Tel: 01244 365 000 Mr P R Edwards Countess of Chester NHS Trust Liverpool Road Chester CH2 1BQ Tel: 01244 365 000 NORTH CHESHIRE HOSPITALS NHS TRUST North Cheshire Hospitals NHS Trust provides most of the acute services for the residents of the North Cheshire. This includes the residents of Warrington, Widnes and Runcorn and some smaller populations such as Newton Le Willows and Frodsham. The community encompasses both industrial and rural areas. Total population is approximately 350,000. THE HOSPITALS: WARRINGTON The Trust provides accident and emergency services for the entire population of North Cheshire with around 70,000 attendances per year. All acute surgical admissions are managed on the Warrington site plus a proportion of elective surgical activity. The surgical directorate (1 of 8) comprises general surgery and its related sub specialties: urology, ophthalmology, ENT, orthodontics, oral and maxillofacial surgery. The ophthalmic and ENT department provide outpatient clinics and day surgery services at Halton Hospital. There is currently an active programme of development within the Hospital. The Appleton wing was opened in 1980 and accommodates medical, surgical and orthopaedic wards, diagnostic services, (including MR and spiral CT scanning), the accident and emergency department, coronary care, ITU/HDU and main theatre complex of 8 theatres. An extensive redevelopment of the accident and emergency department has recently been completed and there are plans to rebuild the Intensive Care and High Dependency units due to increasing demand. A twin roomed endoscopy unit was opened in 2000. Burtonwood wing was opened in 1988 and houses the paediatric wards, and also the rehabilitation and assessment wards for medicine and elderly care. It also contains the paediatric outpatient department and Women’s Day Care Unit. In 1994, the Croft wing was opened to accommodate obstetrics and gynaecology and the 20 cot neo-natal unit. The following year, the Kendrick Wing was converted into a designated Ophthalmic Centre with its own theatre suite. Outpatient clinics in cardiothoracic and plastic surgery are also provided. The main hospital entrance has recently been redeveloped with a parade of shops and restaurants on-site. HALTON Halton General Hospital, Runcorn, provides a significant proportion of the elective surgical and endoscopic services to the North Cheshire population. A good range of radiological facilities are available including spiral CT and interventional radiology. There are two fully equipped Operating Theatres, a four bedded High Dependency Unit and two Coronary Care Unit beds. There are over 39,000 attendances at the Minor Injuries Unit but all major surgical emergencies are seen on, or transferred to, the Warrington site. Acute medical patients are admitted to Halton Hospital. Outpatient clinics in Ophthalmology and ENT are F JD/GEN SURG.SPR April 2005 7
    • also provided. THE SURGICAL ACCOMMODATION: WARRINGTON Currently, the surgical department accommodation comprises 59 acute adult inpatient beds and 34 five day/day case beds. The following facilities are available on a shared basis with other departments:- • 10 paediatric surgical beds • 6 ITU beds • 4 HDU beds • 20 bed endoscopy unit with Argon Plasma Coagulator for gastro-intestinal use • Acute Pain team providing epidural support to the wards One of the 7 day wards is the designated colorectal/gastro-intestinal ward with supporting specialised nursing input. The other wards provide the surgical emergency assessment unit (SAU) and the vascular/ENT teams. There is a bay on the assessment unit which is available for close monitoring of high risk and post operative patients. HALTON The surgical accommodation presently comprises 66 beds, as shown below:- • 56 inpatients (two wards) • 17 bedded Day Case Unit with nine reclining chairs and its own Operating Theatre. • A twin room endoscopy unit equipped with Nd-YAG Laser. SURGICAL STAFFING The merged Trust has the following complement of surgical staff most of whom (but not all) work across both hospitals: Consultant staff: There are ten consultant surgeons providing a wide range of general surgical and subspecialty services. The subspecialty interests are as follows: • Colorectal: Mr Taylor, Mr Tighe, A Razeq • Vascular: Mr Moody, Mr Olojuba and Mr Nicholas • Breast: Mr Copeland, MR Lund • Upper GI: Mr Brett Non-consultant career grade staff: • Associate Specialists:Mr Bohra , Mr Filobbos, Mr Rahim • Staff Grade: Mr Suresh, Mr Javed, Mr Iqbal, Mr Mukhopadhyay F JD/GEN SURG.SPR April 2005 8
    • PATHOLOGY SERVICES The Clinical Director of Pathology is Dr Mohammed Al-Jafari who oversees a Department which provides services on both sites and supports Multidisciplinary Meetings which for the Colorectal Department are held currently on both sites but are being rationalised following Cancer Network recommendations. Haematological support is provided by Dr Khin Swe. Chemical pathology support is provided by Dr Alison Davis and Microbiology by Dr Ronan Garvey – a second microbiologist is currently being recruited. RADIOLOGY SERVICES The Clinical Director of Radiology is Dr Daniel Asamoah and both sites have Xray Departments. Both sites have facilities for Spiral CT, MR and interventional techniques. One screening room has been refurbished on the Warrington site recently and the same is planned for Halton 2005/6. The Department is currently understaffed and efforts are being made to recruit to establishment. Changes in work patterns are likely in the near future such that consultant radiologists will adopt a cross site approach to the delivery of services. EDUCATIONAL ACTIVITIES Facilities Both Halton and Warrington Hospitals have excellent Postgraduate Centres with good library, reference, lecture theatre and computer facilities. The Postgraduate Tutors are Dr Anne Maloney at Halton and Dr Richard Briggs at Warrington. The Surgical Tutors are Mr Martin Brett and Mr Jim Johnson at Warrington and Halton respectively. There is a Clinical Sub dean (Mr Paul Jamieson) who has responsibility for Undergraduate matters. There is an intention to appoint a Director of Education in the future to oversee the delivery of educational activities and the management of the Postgraduate Centres. Medical photography services are available on the Halton site. Audit There is an active Audit Department the Chairman of which is Mr Graham Copeland. Surgical Audit takes place on a monthly basis and the programme is currently being developed around NICE guidelines. Elective commitments are cancelled to allow attendance for CPD purposes. All junior staff are encouraged to present an Audit Topic during their attachment. Teaching There is an active teaching programme on both sites both for undergraduates and surgical trainees. The post holder would be expected to contribute to these in an active manner. Medical students from the University of Liverpool are accommodated on both sites and there is likely to be a significant increase in their number for the academic year 2005/6. KEY MANAGEMENT PERSONNEL: Mr Martin Brett Surgical tutor HR personnel manager Tel 01925 662451 01925 662253 F JD/GEN SURG.SPR April 2005 9
    • MID-CHESHIRE HOSPITALS NHS TRUST LEIGHTON HOSPITAL HOSPITAL AND AREA Leighton Hospital is a large District General Hospital for the South Cheshire area, which was opened in 1972. It has approximately 650 beds and serves a population of 280,000. The Health District is mainly rural but within its boundaries are the towns of Crewe, Nantwich, Northwich, Middlewich and Sandbach. The hospital is situated 2 miles from the centre of Crewe in pleasant rural surroundings. The Department has 84 adult beds together with a 14-bedded Surgical Assessment Unit. Beds are available also on the Child and Adolescent Unit. The Department of General has evenly distributed grades. Four additional clinical / research fellows support the SpR and BST rotas. The hospital has 8 major theatres, and a separate brand new Day Treatment Centre (4 theatres and 4 endoscopy rooms). There is a fully staffed emergency operating theatre continually available. The Department has a strong training ethos and this is reflected in the level of competition for rotational SpR positions at our Hospital. ACTIVITY Daily Ward Rounds (2-3 Consultant Rounds per week) 4 Operating Lists per week 2 Outpatients Clinics The Consultants run a “Consultant of the Week” emergency rota, during which period most elective activity is dropped. This allows close supervision and training of SpR’s in the available emergency surgery. Weekly surgical meetings including, audit, breast screening, duplex scan, case presentation and journal club, combined Gastroenterology, vascular and cancer MDT meetings. Commitment to teaching BST’s, medical students and to nursing staff, in the wards and in theatre is expected. A clinical research commitment is strongly encouraged and expected. STUDY AND TRAINING: There is a well-equipped library in the Postgraduate Centre. Leighton Hospital is within easy reach by road and rail of the major teaching hospitals of Manchester and Liverpool. OTHER FACILITIES There are a wide variety of sports and activities in the area. With Crewe’s excellent rail connections such centres as Manchester, Liverpool, Chester, Stoke on Trent and rural areas such as Wales and the Pennines are a short journey away. CONTACTS Ms A Boyle Mr. D J. Corless Personnel Officer Clinical Lead Mid Cheshire Hospital NHS Trust Mid Cheshire Hospital NHS Trust Leighton Hospital Leighton Hospital Middlewich Road Middlewich Road Crewe Crewe CW1 4QJ CW1 4QJ Tel: 01270 255 141 Tel: 01270 255 141 anne.boyle@mcht.nhs.uk david.corless@mcht.nhs.uk F JD/GEN SURG.SPR April 2005 10
    • EAST CHESHIRE HOSPITALS NHS TRUST MACCLESFIELD DISTRICT GENERAL HOSPITAL HOSPITAL AND AREA Macclesfield District General Hospital is a nucleus style hospital, the first phase of which was opened in 1983. This has been complemented more recently by the acquisition of a further wing in which the Orthopaedic Department is situated. All acute medical services are now based in Macclesfield District General Hospital. Macclesfield DGH 361 beds Parkside Hospital 279 beds (Mental Illness) Congleton War Memorial Hospital 28 beds (GP/Rehab/long stay/respite) Cranford Lodge Hospital 18 beds (GP/rehab/long stay/respite) Mary Dendy Unit 10 beds (Learning Disabilities) ---------------- 696 beds ---------------- The Surgical Directorate comprises of three wards each with a bed complement of 28, assessed by the specialties of general surgery, Urology, ENT and oral surgery. Of the total establishment 10 beds are designated for day case surgery and a four- bedded bay operates as a High Dependency Unit. The remaining bed allocation is utilised flexibly to meet the demands of services provided by the directorate. Surgical paediatric beds are located on the paediatric wards which, consists of 26 paediatric and medical beds. In addition, a further six beds are located within the endoscopy facility accessed by general surgery and medicine for patients undergoing outpatient procedures. The Trust also provides access to four ICU beds, of which three are currently funded. Bed allocation for General Surgery and other specialties are under regular review. Presently there are six Consultant Physicians whose specialist interests include Gastroenterology, Diabetics and Endocrinology, Cardio-Vascular disease, Respiratory Medicine, Care of the Elderly and Rehabilitation. The Trust has recently been successful in the appointment of a Dermatologist and two Consultant Rheumatologists. Five Consultant Radiologists undertake a full range of investigations including MR scanning, CT scanning, ultrasound, isotope imaging and angiography. A comprehensive range of pathology services is provided on the West Park site with Consultants in all four main disciplines. The Day Suite offers a fully integrated unit with specialised facilities for endoscopic intervention. These include endoscopy, sigmoidoscopy, colonoscopy, gastroscopy, bronchoscopy, colposcopy and laser therapy. Endoscopic retrograde cholangiopancreatography (ERCP) is serviced by the F JD/GEN SURG.SPR April 2005 11
    • department with access to radiological imaging. The theatres complex offers 6 theatres on two sites (x4 main theatres and x2 theatres located in the Orthopaedic department). Two theatres have dedicated facilities, ie one maternity and one orthopaedic containing lamina flow. ACTIVITY The Trust is currently purchasing an extensive range of patient-based information systems. The new systems will be underpinned by technical criteria to ensure that all systems which collect and repeat on patient information will be able to communicate simply and swiftly. This strategy will enable internal and external communications with other departments and providers of health care such as GP Practices. this will obviously enhance the delivery of patient care. The Directorate holds a monthly audit meeting to which all medical staff are invited. Final year students from Manchester are attached to the Surgical Directorate in the early part of the year. Fourth year students from Manchester are attached throughout the year. There is an active Postgraduate Medical Centre with a comprehensive medical library and facilities for literature searches via Medline. Regular clinical meetings are held in this centre and these are well supported by hospital staff and local General Practitioners. The centre is staffed by a full time administrator and a librarian. An excellent catering service is available within it and the centre acts as a focus for doctors of all disciplines to meet. Academic links are with both the University Departments of Manchester and Liverpool. Plans are being developed for a new Multi- Disciplinary Education Centre on the West Park site. There is a commitment to teach junior medical staff and a regular weekly tutorial session is held in which all Consultant staff are expected to take part in rotation. There is also a weekly case presentation. Regular tutorials are held in radiology. TUTORIALS AND MEETINGS A modern, active Postgraduate Centre offers a range of facilities including lunch-time meetings throughout each academic term. The centre contains an excellent library, with access to the British Library available through the librarian. In addition there are weekly surgical lunch-time meetings including a monthly morbidity and mortality meeting. One afternoon a month is devoted to a surgical audit meeting which all members of the department are expected to attend. The successful candidate will be expected to participate in the Postgraduate activities and/or departmental training programme. One of the Specialist Registrar will act as Junior Staff Representative at the meetings of the Surgical Directorate which meets monthly CONTACTS Mr C Rosenhall Mrs C Edge Consultant Surgeon/Surgical tutor Personnel Officer Macclesfield District General Hospital Macclesfield District General Hospital Victoria Road Victoria Road Macclesfield Macclesfield Tel: 01625 421 000 SK10 3BL Tel: 01625 421 000 ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITAL NHS TRUST HOSPITAL AND AREA The Royal Liverpool and Broadgreen University Hospital NHS Trust was opened in 1978 and is the major teaching hospital in the North West for the University of Liverpool. It became a self- governing Trust within the NHS in April 1991. F JD/GEN SURG.SPR April 2005 12
    • The trust contains approximately 1200 beds and is a provider of clinical services in most of the main medical and surgical specialities department. Many of these departments, in addition to offering a service to the local community, offer a service of tertiary referral both within and without the North West Region. There are very close ties with the Faculty of Medicine of the University of Liverpool. The clinical academic departments of the Faculty are on the same site as the Hospital. The Hospital has special strength in medical and Surgical Gastroenterology and Surgical Oncology. Because of the strength of neighbouring stand-alone units in Paediatrics and women’s services, there is no provision of Paediatrics or Obstetrics and Gynaecology at the Royal. Likewise, the hospital does not seek to provide services in Cardiothoracic Surgery, Neurosurgery or Plastic Surgery, all of which are concentrated in Regional Units in nearby hospitals. As a first wave NHS Trust the Hospital has put in place a vigorous system of Clinical Directorates and Resource Management. There is a robust and developing culture of medical audit co- ordinated throughout the hospital, and integrated with the overall hospital policy of Quality Assurance and Risk Management. CONTACTS Heather Bennett Mr Mike Raraty Personnel Department Consultant in charge of Rota/educational supervisor HST Royal Liverpool University and Broadgreen Hospital NHS Trust Prescot Street el 0151 706 3408 Liverpool L7 8XP Tel: (0151) 706 2813 Fax: (0151) 706 5412 SpR PROFESSORIAL SURGICAL UNIT ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITAL NHS TRUST (RLUH SITE) THE POST There are two Specialist Registrars in post on this Unit. The activities on the Unit are shared amongst the three academic surgeons who work as a single unit covering lists and clinics and participating in Grand Ward Rounds. The Unit is very busy dealing in particular with major and complex pancreatic cases, many of whom are tertiary referrals from around the Region and also Nationally. There is a major emphasis on pancreatic cancer surgery reflected in the numbers of pancreatic resections exceeding 50 per year. The detailed daily activity of the SpR is shown in the enclosed job plan, but the SpR is expected to supervise and lead on ward rounds, to organise waiting list activity and to prioritise patients. There is opportunity to operate as a principle operator in major pancreatic cases and also to experience the post-operative care of such patients, including the management of difficult complications. Ward rounds are primarily based on ward 5B, but do involve other wards throughout the hospital. Clinics are busy with a big tertiary referral practice. RECOGNITION Both of the SpR posts are currently recognised for training purposes. TRAINING The SpR will expect to learn techniques of complex major pancreatic surgery. There is also the opportunity to learn interventional ERCP. The Unit is backed by an excellent interventional radiological and interventional gastroenterological group who have joint multi-disciplinary meetings on a regular basis. F JD/GEN SURG.SPR April 2005 13
    • FACILITIES IN THE UNIT The Professorial Surgical Unit has ward 5A/B as its designated ward area. Annexed to this ward is a four bedded High Dependency unit. In addition there is a post-operative unit (POCCU) on the 11th floor close to theatres, which provides 24-48 hour care for patients in the immediate post- operative critical care recovery phase. There is also a 13 bedded Intensive Care Unit on the 1 st floor. There is a large busy Gastroenterology Directorate with 7 Gastroenterological Consultant colleagues who provide an excellent interventional ERCP service. In addition, there is a radiological interventional service with high quality spiral CT and MRI imaging. AUDIT/CLINICAL GOVERNANCE There is a monthly Clinical Governance audit programme, which analyses sub-speciality topics, CEPOD data in association with the Anaesthetists and clinical incident risk management issues. RESEARCH The Professorial Surgical Unit has an excellent record in research activity. Further details can be obtained from Professor John Neoptolemos. TEACHING There are currently a number of multi-disciplinary meetings to which the SpR is expected to attend, and in the near future there will be a SpR teaching programme established which may be based at the Royal or possibly rotate through various hospitals within the Mersey region. Professor J Neoptolemos Head of Department University of Liverpool Duncan Building Daulby Street Liverpool L69 3GA Tel: (0151) 706 3451 (0151) 706 4175 Fax: (0151) 706 5828 (0151 706 5798 REGIONAL TRANSPLANT SURGERY UNIT ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITAL NHS TRUST (RLUH SITE) THE POST The Specialist Registrar is required to carry out and supervise, (with the Senior Registrar) the surgical treatment of patients suffering chronic and acute renal failure in the Renal Transplant Unit, in close co-operation with the Consultant Surgeons and physicians attached to the unit, and junior colleagues. He/she will be trained in and will carry out the following surgical techniques: cadaveric and living related renal and pancreatic transplantation, pre and post transplant surgical procedures necessary for the preparation of patients for transplantation and for the treatment of complications, vascular and peritoneal access procedures, and cadaveric organ removal. The incumbent will also be responsible, with the ST1 and 2’s, for the day to day care of the patients, most of whom are on immunosuppressive drugs. RECOGNITION This post is recognised by the Specialist Advisory Committee for training purposes in General Surgery and Transplant Surgery and will be of interest to Specialist Registrars on the Overseas Doctors Training Scheme. F JD/GEN SURG.SPR April 2005 14
    • THE CLINICAL LOAD Patients are referred to the Transplant Unit (which is a District managed Regional unit) from Merseyside and North Wales, for transplantation and vascular access. In addition, there is a significant number of referrals from the Halewood Acute Dialysis Unit at the Royal Liverpool University Hospital. In these, as in all cases referred to the unit, there is very close liaison between the Specialist Registrar and the Consultant Surgeons and Physicians. In one year the unit will deal with approximately 600 vascular access procedures, 70 - 80 renal and pancreatic transplants, 40 cadaver organ retrievals, and approximately 200 other surgical procedures. TRAINING The incumbent will receive close supervision in all the techniques described above, and will be encouraged to undertake these surgical procedures independently albeit with a consultant available to assist. The successful applicant will be expected to have at least two years experience in general and/or vascular surgery and will have completed his or her Fellowship examinations. Previous experience in transplant work is not considered essential for this post. FACILITIES IN THE UNIT There is a comprehensive computerised data storage and retrieval system dedicated to transplant and dialysis patients, which is used daily for the management of post operative transplant patients on the ward. A Duplex ultrasound scanner is situated on the Transplant Unit for grey-scale and Doppler imaging and physiological measurement, operated by two unit ultrasonographers. The Transplant Unit has 13 beds; the patients are looked after by an expert team of nurses who also carry out all the dialysis procedures on the unit. There are 13 District General Hospitals in Merseyside and North Wales who refer cadaveric organ donors. AUDIT Prospective audit is practised by all staff. The successful applicant will be responsible for the collation and presentation of departmental audit data at audit meetings. FACILITIES AT THE HOSPITAL The Royal Liverpool University Hospital is exceptionally well equipped for all diagnostic and therapeutic procedures necessary for the efficient care of transplant patients. There is 24 hours access to the accident and emergency theatres and all routine pathology services. The Radiology Department is equipped for emergency and elective diagnostic procedures, including MRI scanning. RESEARCH The unit has a good record of clinical investigation and staff contribute regularly to national and international meetings. The Specialist Registrar will be encouraged to take an active part in clinical research and will have the opportunity of authorship on original publications. Attendance at meetings of the International Transplantation Society and the British Transplantation Society will be encouraged, and funds are available for this. One half day per week available for private study and research. TEACHING The Specialist Registrar may choose to teach General Surgery to medical undergraduates, and will be expected to give occasional lectures within and outside the hospital about Transplant Surgery. There is also a nursing course in renal medicine to which he or she will be expected to contribute lectures. F JD/GEN SURG.SPR April 2005 15
    • VISITS TO THE UNIT Consultants will be happy to see prospective trainees. Please ring Mr A Hammad’s Secretary on Tel: 0151 706 2664 for an appointment. SOUTHPORT AND ORMSKIRK NHS TRUST SOUTHPORT & FORMBY DISTRICT GENERAL HOSPITAL INTRODUCTION AND PROFILE OF THE AREA The elegant seaside town of Southport is situated on the North West coast approximately 20 miles north of Liverpool, 15 miles south of Preston with Manchester 45 miles inland. The residential suburbs of Freshfield & Formby lie 7 miles south of Southport with the villages of Tarleton, Banks and Hesketh Bank 3 to 5 miles north of the town. The population of Southport and Formby together is approximately 116,000. The outlying area of green belt is made up of rich arable farming and market gardening. Large industry is at a minimum in the immediate area. Southport is a victorian town which boasts one of the finest shopping streets in the centre, Lord Street. The town is also famous for its golf courses - 9 in all. Southport & Formby are served by an excellent network of roads to Liverpool, Manchester and Preston. Trains run directly to these cities and the airports of Manchester and Liverpool are readily accessible. Both Southport & Formby are ideally situated within easy travelling distance of the Lake District, Yorkshire Dales and the mountains and coast of North Wales. There is an excellent choice of housing in both Southport and Formby, much of it within easy access of the District's hospitals. There is a wide choice of schools, including state maintained, nursery and private. There is also a Technical College in Southport itself. The rail link with Liverpool makes many more schools available. Southport has a particularly good range of hotels and is a developing conference centre. It also has a good choice of both restaurants and night clubs. There is a full range of sporting, cultural and recreational facilities within the area including the internationally famous Royal Birkdale Championship golf course. WEST LANCASHIRE West Lancashire is largely rural with a number of small villages and arable farmland scattered around the ancient market town of Ormskirk and the "new" town of Skelmersdale, 5 miles to the east. The area's population is approximately 109,000. Southport lies 8 miles to the west with Liverpool and Manchester within 3/4 of an hour by car or rail. There is easy access to the M58 and M6. Ormskirk itself has a very good choice of housing with many attractive developments in the surrounding countryside. All levels of schooling are available, with Edge Hill University College situated just outside the town. PROFILE OF HOSPITALS The Southport & Ormskirk Hospital NHS Trust was formed out of the merger on 1 April 1999 of the acute hospitals in the two towns. Southport and Ormskirk Hospital NHS Trust Southport DGH 361 beds Ormskirk DGH 316 beds Southport General Infirmary 36 beds Wrightington Hospital NHS Trust 170 beds Renacres Hall Hospital (private) 32 beds The main surgical Unit is at Southport and comprises of 56 beds (42 in 7 day ward and 14 on 5 day ward and in addition there are up to 9 day case beds). F JD/GEN SURG.SPR April 2005 16
    • Southport and Ormskirk Hospitals provide a comprehensive secondary referral service for the local populations. This includes General medicine and Surgery, Orthopaedics and Trauma, Obstetrics and Gynaecology, Paediatrics and Neonatal medicine, Clinical Haematology, Cardiology, Gastroenterology, Rheumatology, Vascular Surgery, Urology, Intensive Care, Rehabilitation Medicine, Psychiatry, Ophthalmology and ENT surgery. There is also a consultant led Accident and Emergency department at both sites. With Trust amalgamation all surgical emergencies are admitted to Southport. In addition, there is a supra-regional referral centre for Spinal Injuries at Southport. ACTIVITY The work within the Department will be carried out under the supervision of the Consultant Medical Staff and will include the day to day care of patients, attendance at ward round and out- patient clinics and assisting or working in the operating theatre. The postholder will be required to provide on call and emergency cover, to assist in postgraduate and undergraduate teaching and to supervise junior medical staff. He/she will also be available for other duties as required. The appointment includes Urology (emergency cover only) and some children’s surgery. This is a resident post and single accommodation will be provided. Married accommodation may be available. Each Consultant has an all day list and one half day list. and 2 out-patient clinics (1 x special interest and 1 x general). The special interests involve breast, pancreatico-biliary, colorectal and upper GI surgery with a surgical ERCP service and vascular surgery. All Consultants are trained in Laparoscopic surgery which is a routine and expanding part of the surgical workload. Specialist Registrars will be encouraged to develop skills in this technique. There is a 6 bedded intensive care unit and 4 bedded HDU, staffed by a Consultant Anaesthetist with a specific interest in intensive care. There are daily ward rounds and it is expected that Junior Surgical Staff attend these rounds for teaching purposes. TUTORIALS AND MEETINGS Clinical meetings, lectures and seminars are held regularly and there will be opportunity for further study at Liverpool University by arrangement. There is a weekly tutorial programme for Specialist Registrars and specialty trainees. There is a well equipped library with multiple internet access. RESEARCH The Surgical Unit is presently admitting patients to many national studies. Protocols are being developed to provide clinical research projects to all rotating staff. Laboratory facilities are available within the academic Department of Surgery at the University of Liverpool. ACCOMMODATION On-call accommodation is provided on site. Single/Married accommodation may be available, should this be required you are requested to contact Mrs Lynne Shaw, Accommodation Officer, Tel: 01704 547471 Ext: 4016. CONTACTS Mr David Jones Mrs Heather Bennett Specialty Tutor Medical Staffing Manager Southport & Ormskirk Hospitals NHS Trust Holmcroft Southport & Formby District General Hospital Southport & Ormskirk Hospital NHS Trust Town Lane Ormskirk & District General Hospital Southport Wigan Road PR8 6NJ Ormskirk, L39 2AZ F JD/GEN SURG.SPR April 2005 17
    • Tel: 01704 547471 Tel: 01695 577 111 Ext 6744 ST HELENS AND KNOWSLEY HOSPITAL NHS TRUST WHISTON HOSPITAL TRUST PROFILE St Helens & Knowsley Hospitals was established as a National Health Service Trust with effect from 21st December 1990, the operational date being 1 April 1991. The Trust provides a comprehensive range of health care services from its three hospitals primarily to the Metropolitan Boroughs of St Helens & Knowsley (population 346,945 - July 1989) and the adjoining districts of Wigan, Halton, Warrington and Liverpool and other parts of the North West Region. The communities of St Helens & Knowsley are of mixed urban and rural character. St Helens is an old established industrial town which is presently undergoing a programme of urban renewal. Knowsley, whilst having a nucleus of small, old established communities with rural areas, largely consists of new developments created to accommodate people from the inner city of Liverpool. The Trust also provides the following special services for the Mersey Region:- Regional Plastic Surgery and Burns Centre Regional Secure Unit (Scott Clinic) The catchment area for the Regional Plastic Surgery and Burns Centre extends to include North Wales and the Isle of Man. The Trust comprises three hospitals and a satellite unit as follows:- Whiston Hospital A District General Hospital of 850 beds providing a comprehensive range of acute Medical and Surgical Services, Major Accident and Emergency Services, Maternity Services, Care of the Elderly, the Mersey Regional Plastic Surgery and Burns Centre, and including a 110 bed Acute Mental Illness Unit (Sherdley Suite); 20 of which are assessment beds. St Helens Hospital A Local Hospital of 152 beds (including 9 day beds), providing elective surgery, all Ophthalmology, Rheumatology and Care of the Elderly Services. The Hospital also has a daytime Minor Injuries Unit. Newton Community Hospital A Local Hospital with 30 beds, catering mainly for the population of Newton-le-Willows, under the management of local GPs. The Hospital also has a busy out-patient Department with Consultant sessions in most specialties. All three Hospitals operate a wide range of out-patient services, provide day care for the elderly and have access to a full range of clinical and non-clinical support services. Scott Clinic Regional Secure Unit (RSU): 42 beds for the care and treatment of mentally-disordered criminal offenders. In addition the Trust has: - Two day hospitals for mental illness - One day hospital for psychogeriatric cases with 25 bedded assessment unit F JD/GEN SURG.SPR April 2005 18
    • THE TRUSTS MISSION To provide for all users of the hospital and clinics a quality service which strives to meet the best standards of professional care, which is sensitive and responsive to the needs of individual patients., Which is innovative in the treatment it provides and which creates for its employees a working environment that allows their professional and personal aspirations to be met to the full. THE WORK OF THE DEPARTMENT OF GENERAL SURGERY The Department of Surgery carries out in-patient and out-patient work at Whiston and St Helens Hospitals. It is a busy department that in addition to General Surgery, provides specialist services in upper GI surgery, Laparoscopic surgery, breast surgery, colorectal surgery and urology. The Department of Surgery includes 4 Surgical Wards at Whiston (84 beds), 3 wards and a Day Ward at St Helens. Completed in April 1996, Whiston Hospital has a new Critical Care Unit which houses the centre for Acute Medical Admissions and a major Accident & Emergency Department, which has in excess of 70,000 admissions per annum. A Regional Specialist service in Plastic Surgery and Burns is also on site at Whiston, and is housed in a newly built unit with excellent treatment and teaching facilities. St Helens is being developed as a non-acute hospital and currently has facilities for elective and day case surgery. The Hospital has a clearly defined programme of clinical audit. All specialties spend one session per month on audit, this occurs at the same time for all specialties allowing an exchange of views between specialties and encourages multi-disciplinary audit. The audit session occurs on a different half day each month rotating from Tuesday morning to Thursday afternoon. A medical audit information system has been installed. The Hospital has a weekly grand round, held in the Postgraduate Centre every Tuesday lunchtime. All disciplines partake on a rotational basis. Consultants of the Service:- Mr M H Scott - General Surgeon with interest in Laparoscopic and Colorectal Miss L Chagla - General Surgery & Breast Disease Mr R Kiff - General Surgery & Lower GI Mr D Maitra - General and Colorectal MR A Kaul - Upper GI Mr R Audisio - Surgical Oncology and Breast Nurse Clinicians commenced duties at St Helens Hospital in November 1996. Their duties include day to day management of post operative ward patients and other procedures by agreement with the Consultant and Nursing Management. THE JOB The post offers wide experience and training in General Surgery, both elective and emergency. Experience will include most aspects of Gastroenterology, including Endoscopy, Gastric, Colonic, Breast and Laparascopic Surgery, routine Paediatric Surgery and Endocrine Surgery. The postholder will be responsible to the Consultant Surgeons for undertaking surgery at their discretion. The weekly programme will include the following:- 2 Ward Rounds F JD/GEN SURG.SPR April 2005 19
    • 2 Clinics 3 Operating sessions 1 Endoscopy session. There are 91 beds at Whiston Hospital and 30 at St Helens Hospital. The main surgical block at Whiston Hospital has been extensively modernised. There is modern surgical ward at St Helens Hospital. This is a General Surgical Unit providing a District General Hospital services including Paediatrics. The major part of the theatre work at Whiston Hospital is undertaken in the main suite which has 4 modern theatres and a new recovery unit. St Helens has 3 modern theatres and a new recovery area. The Department has links with the University of Liverpool Medical School, and undergraduate teaching of final year students is undertaken in the Unit from September to April. ADMINISTRATION The Specialist Registrar may be asked to help with the planning of the surgical part of the weekly postgraduate meeting in the hospital and other unit meetings including regular audit meetings. Specific details of the day to day programme will depend upon which firm the person is working. One session will be allocated for teaching the final year students and there will be time for doing own ward rounds and teaching juniors. TEACHING The Specialist Registrar will be responsible for teaching the final year students on a session week. She/he may be responsible for assisting in the organising of the terminal student examinations. She/he will also be responsible for assisting in the teaching of junior surgical staff in training. Occasional lectures to nurses may be undertaken. TUTORIALS AND MEETINGS There is an active postgraduate programme with weekly tutorials AGrand≅ Rounds, and a Journal Club. Surgical Audit, x-ray and Pathology meetings are held on a monthly basis. The postholder is expected to provide them with tutorial and bedside teaching on a weekly basis to organise a mock AFinal Exam≅ at the end of their attachment. The unit has the AMicromed≅ computer system for its data storage and discharge summary generation. The postholder is expected to become familiar with the system and supervise its use by the more junior staff of the Unit. There will be an opportunity in the weekly programme to take a day study leave if so desired. There is a monthly Gastroenterological meeting held in the hospital. CONTACTS MR D Maitra Consultant Surgeon and speciality tutor St Helens & Knowsley Hospitals NHS Trust Whiston Hospital Warrington Road Prescot Merseyside L35 5DR F JD/GEN SURG.SPR April 2005 20
    • Tel: 0151 426 1600 Mrs F Connolly Medical Staffing Officer St Helens & Knowsley Hospitals NHS Trust Whiston Hospital Warrington Road Prescot Merseyside L35 5DR Tel: 0151 426 1600 WIRRAL HOSPITAL NHS TRUST HOSPITAL AND AREA The Wirral Hospital Trust is one of the largest in North West England. Formed (1991) by the amalgamation of 2 sites of Clatterbridge and Arrowe Park Hospital, it serves a population of 354,000 in up-to-date facilities. The Wirral Hospital is one of the Government’s 6 original Resource Management Initiative Sites. Most departments interact with one another via the computer Patient Care Information System (PCIS). Requests for investigations, etc, are made via computer terminals present on all wards, in operating theatres, clinics and secretarial offices. Standard discharge letters can be generated – free text may be added. Results of investigations and details of previous admissions may be retrieved on screen. ARROWE PARK HOSPITAL SITE All emergency admissions and major surgical cases whose condition (or proposed treatment) may require support of ITU or medical specialities occur here, as do those of children. Surgery is accommodated in three 30 bed wards plus the Surgical Admission Unit, 14 Urology beds and Paediatric Surgical beds. All acute services are provided here including General Surgery, Urology, Orthopaedic Surgery, Obstetrics and Gynaecology, Ophthalmology, ENT and Oral Surgery. Well established medical departments provide for Care of the Elderly, Gastroenterology, Diabetes, Endocrinology, Nephrology with haemodialysis and Cardiology including coronary angiography. Full radiological services are provided with a new angiography suite, Spiral CT scan, MRI and a cardiovascular investigation suite including duplex scanning for peripheral vascular disease. There are 14 operating theatres including a 24 hour emergency theatre, a trauma theatre, and a Paediatric Day Unit. CLATTERBRIDGE HOSPITAL SITE Elective adult in-patient and day surgical treatment is conducted in a new purpose built facility which provides 6 theatres and an endoscopy room linked to 2 General Surgical In-patient Wards, a Day Ward and a Pre-operative Assessment Unit. Out-patient facilities are on both sites with the Breast Care out-patients unit being at Clatterbridge. There is close co-operation with the Clatterbridge Centre for Oncology which is on the same site providing Radiotherapy and Oncological advice. St Johns Hospice is also on this site. PRINCIPAL RELATIONSHIPS WITH OTHER STAFF The holder will be required to work with other medical, secretarial, technical and nursing staff as appropriate. ACTIVITY All aspects of General Surgery are covered including emergency surgery and laparoscopic F JD/GEN SURG.SPR April 2005 21
    • surgery. Consultant members of each firm have one or more special interests. Close co- operation between members of different firms is necessary. The 9 Specialist Registrars will be deployed to firms as follows: 1) All these posts provide a large amount of clinical material ideal for both general surgical training and if appropriate Sub-speciality training. The holder of this post is expected to supervise the ST1 and 2. He or she will undertake daily ward rounds and supervise the day-to-day management of patients. At weekends (with ST1 and 2 and F2s) the Specialist Registrar will ensure that consideration is given to every in-patient case each day. 2) The teaching duties will include tuition of House Officers and the teaching of Final Year Medical Students during the academic year. Participation in weekly clinical and monthly audit meetings is expected. 3) Research. There are no specific research duties but the holder of the post will be encouraged to undertake clinical research. Contact with the University Department of Surgery is encouraged. Specialist Registrars will be helped to present and to publish their work. 4) Administration to co-ordinate admission and discharge procedures, compilation of theatre lists, etc, as required. The appointee will have access to one of the most comprehensive and innovative expressions of Information Technology in any hospital in the UK and is expected to master its use and to encourage other medical staff to do so. TUTORIALS AND MEETINGS a) Library Facilities There is a new Multi-disciplinary Education Centre at Arrowe Park. There is a Postgraduate Centre at Clatterbridge. These have a Librarian and by their contacts outside Wirral and though Medline give an extensive service. Liverpool Medical Institution and the Cohen Library provide additional facilities in central Liverpool. b) Other Postgraduate Medical Education courses available locally include a full programme of Postgraduate Meetings at both Clatterbridge and Arrowe Park Hospital sites. Use of study leave to attend appropriate course and national meetings will be encouraged. The Wirral Hospital will meet the requirements of the Postgraduate Dean and the Royal College of Surgeons of England. Shortlisted Applicants who would like to view the hospital are asked to contact the Directorate Manager – Tel: 0151 678 5111, Ext 2295/2553. CONTACTS Mr M S Javed Miss C A Makin Speciality Tutor Clinical Director Wirral Hospital NHS Trust Wirral Hospital NHS Trust Arrowe Park Hospital Arrowe Park Hospital Arrowe Park Road Arrowe Park Road Upton Upton Wirral Wirral CH49 5PE CH49 5PE Tel: 0151 604 7493 Tel: 0151 604 7058 MS Evelyn Rogansky Medical Staffing Officer and in charge of HST in region F JD/GEN SURG.SPR April 2005 22
    • Human Resources Department Wirral Hospital NHS Trust Arrowe Park Hospital Arrowe Park Road Upton Wirral CH49 5PE Tel: 0151 678 5111 ext 8510 F JD/GEN SURG.SPR April 2005 23