Other Medicine and Health Sciences Commons^™

Perceptions Of Medical Students And Their Supervisors Of The Preparation Of Students For Clinical Placement In Obstetrics And Gynecology, Patricia Johnson, Patricia Green, Peter Jones, Heather James

Patricia Green

Background: Research is limited regarding the adequacy of preparation of medical students for their placement in obstetrics and gynecology. The aim of this study was to determine the perceptions of a cohort of undergraduate medical students from an Australian university and their clinical supervisors of the on-campus preparation of students for their clinical rotation in obstetrics and gynecology. Methods: We used a descriptive exploratory qualitative research approach and purposive sampling to address the aim of the study. Ten undergraduate medical students and 4 of their supervisors participated in the study. Data were collected from focus group discussions, follow-up interviews, and …

Absolute And Relative Changes (Delta) In Troponin I For Early Diagnosis Of Myocardial Infarction: Results Of A Prospective Multicenter Trial., Alan B Storrow, Richard M Nowak, Deborah B Diercks, Adam J Singer, Alan H B Wu, Erik Kulstad, Frank Lovecchio, Christian Fromm, Gary Headden, Tracie Potis, Christopher J Hogan, Jon W Schrock, Daniel P Zelinski, Marna Greenberg, Robert H Christenson, James C Ritchie, Janna S Chamberlin, Kurtis R Bray, Daniel W Rhodes, Deirdre Trainor, Paula C Southwick

Marna R Greenberg DO, MPH, FACEP

OBJECTIVES: We investigated absolute and relative cardiac troponin I (TnI) delta changes, optimal sampling protocols, and decision thresholds for early diagnosis of myocardial infarction (MI). Serial cardiac biomarker values demonstrating a rise and/or fall define MI diagnosis; however the magnitude of change, timing, and diagnostic accuracy of absolute versus relative (percentage) deltas remains unsettled. METHODS: We prospectively measured TnI (AccuTnI+3™, Beckman Coulter) at serial time intervals in 1929 subjects with chest pain or equivalent symptoms of acute coronary syndrome at 14 medical centers. Diagnosis was adjudicated by an independent central committee. RESULTS: Elevated TnI above a threshold of 0.03ng/mL demonstrated …

Mass Gathering Medical Planning: An Overview Of The Australian Surf Life Saving Championships, David Reid, Stephen Leahy, Anne-Marie Widermanski

David N Reid

This article provides an overview of the Aussies, outlines its medical planning and role of the medical team, and describes the team structure. Equipment and team deployment is described. This article also identifies some of the challenges that the Aussies present to medical planners because of the unique factors which influence the number and type of patient presentations. Finally, improvement recommendations are made which outline a number of simple, yet key strategies which will improve medical planning in the future.

Longitudinal Investigation Of Natural Killer Cells And Cytokines In Chronic Fatigue Syndrome/Myalgic Encephalomyelitis, Ekua Brenu, Mieke Van Driel, Donald Staines, Kevin Ashton, Sharni Hardcastle, James Keane, Lotti Tajouri, Daniel Peterson, Sandra Ramos, Sonya Marshall-Gradisnik

Lotti Tajouri

Background: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is an etiologically unexplained disorder characterised by irregularities in various aspects of the immunological function. Presently, it is unknown whether these immunological changes remain consistent over time. This study investigates Natural Killer (NK) cell cytotoxic activity, NK cell subsets (CD56brightCD16- and CD56dimCD16+) and cytokines, over the course of a12 month period in patients with CFS/ME. Methods: The participants in the study comprised 65 (47.2 ± 11.5 years) CFS/ME participants and 21 (45.2 ±9.3 years) non-fatigued controls. Flow cytometry protocols were used to assess NK subsets and NK cytotoxic activity at various time points that …

Clinical And Laboratory Features That Distinguish Dengue From Other Febrile Illnesses In Endemic Populations, James Potts, Alan Rothman

Alan Rothman

OBJECTIVE: Clinicians in resource-poor countries need to identify patients with dengue using readily-available data. The objective of this systematic review was to identify clinical and laboratory features that differentiate dengue fever (DF) and/or dengue haemorrhagic fever (DHF) from other febrile illnesses (OFI) in dengue-endemic populations. METHOD: Systematic review of the literature from 1990 to 30 October 2007 including English publications comparing dengue and OFI. RESULTS: Among 49 studies reviewed, 34 did not meet our criteria for inclusion. Of the 15 studies included, 10 were prospective cohort studies and five were case-control studies. Seven studies assessed all ages, four assessed children …

Poor Description Of Non-Pharmacological Interventions: Analysis Of Consecutive Sample Of Randomised Trials, Tammy Hoffmann, Chrissy Erueti, Paul Glasziou

Chrissy Erueti

Objectives: To evaluate the completeness of descriptions of non-pharmacological interventions in randomised trials, identify which elements are most frequently missing, and assess whether authors can provide missing details. Design: Analysis of consecutive sample of randomised trials of non-pharmacological interventions. Data sources and study selection: All reports of randomised trials of non-pharmacological interventions published in 2009 in six leading general medical journals; 133 trial reports, with 137 interventions, met the inclusion criteria. Data collection Using an eight item checklist, two raters assessed the primary full trial report, plus any reference materials, appendices, or websites. Questions about missing details were emailed to …

Perceptions Of Medical Students And Their Supervisors Of The Preparation Of Students For Clinical Placement In Obstetrics And Gynecology, Patricia Johnson, Patricia Green, Peter Jones, Heather James

Patricia Johnson

Background: Research is limited regarding the adequacy of preparation of medical students for their placement in obstetrics and gynecology. The aim of this study was to determine the perceptions of a cohort of undergraduate medical students from an Australian university and their clinical supervisors of the on-campus preparation of students for their clinical rotation in obstetrics and gynecology. Methods: We used a descriptive exploratory qualitative research approach and purposive sampling to address the aim of the study. Ten undergraduate medical students and 4 of their supervisors participated in the study. Data were collected from focus group discussions, follow-up interviews, and …

Unexplained Variation Across Us Nursing Homes In Antipsychotic Prescribing Rates., Yong Chen, Becky Briesacher, Terry Field, Jennifer Tjia, Denys Lau, Jerry Gurwitz

Jennifer Tjia

BACKGROUND: Serious safety concerns related to the use of antipsychotics have not decreased the prescribing of these agents to nursing home (NH) residents. We assessed the extent to which resident clinical characteristics and institutional prescribing practice were associated with antipsychotic prescribing.

METHODS: Antipsychotic prescribing was assessed for a nationwide, cross-sectional population of 16 586 newly admitted NH residents in 2006. We computed facility-level antipsychotic rates based on the previous year's (2005) prescribing patterns. Poisson regressions with generalized estimating equations were used to identify the likelihood of resident-level antipsychotic medication use in 2006, given 2005 facility-level prescribing pattern and NH resident …

Perceived Accessibility As A Predictor Of Youth Smoking, Chyke Doubeni, Wenjun Li, Hassan Fouayzi, Joseph Difranza

Chyke A. Doubeni

PURPOSE: Youths who smoke are more likely to perceive that cigarettes are easily accessible, but the relationship between perceived accessibility of cigarettes and the risk of smoking is not clear. The objective of this study was to determine whether perceived accessibility predicted future smoking among youths. METHODS: This study used data from the second Development and Assessment of Nicotine Dependence in Youth (DANDY-2) study, a 4-year (2002-2006) cohort study that began with 1,246 sixth-grade students in 6 Massachusetts communities. DANDY-2 comprised 11 waves of in-person interviews. A total of 1,195 students who were aged 11 to 14 years at the …

Perceived Accessibility Of Cigarettes Among Youth: A Prospective Cohort Study, Chyke Doubeni, Wenjun Li, Hassan Fouayzi, Joseph Difranza

Chyke A. Doubeni

BACKGROUND: The accessibility of tobacco for youth is difficult to measure, partly because of the varied sources of cigarettes. Perceptions about the accessibility of cigarettes assesses availability from all potential sources and has been found to predict future smoking. This study examines the determinants of perceived accessibility from the perspective of a longitudinal study. METHODS: Data were derived from the second Development and Assessment of Nicotine Dependence in Youth study, a 4-year longitudinal study of 1246 sixth-grade students who underwent up to 11 in-person interviews from 2002 to 2006. Perceived accessibility was assessed prospectively by asking students whether they agreed …

Disparities And Survival Among Breast Cancer Patients, Terry Field, Diana Buist, Chyke Doubeni, Shelley Enger, Hassan Fouayzi, Gene Hart, Eli Korner, Lois Lamerato, Donald Bachman, Jennifer Ellis, Lisa Herrinton, Mark Hornbrook, Richard Krajenta, Liyan Liu, Janice Yao

Chyke A. Doubeni

BACKGROUND: Although rates of survival for women with breast cancer have improved, the survival disparity between African American and white women in the United States has increased.

PURPOSE: To determine whether this survival disparity persists in an insured population with access to medical care.

METHODS: In this retrospective cohort study, we extracted data from the tumor registries of six nonprofit, integrated health care delivery systems affiliated with the Cancer Research Network and assessed the survival of African American (n = 2276) and white (n = 18 879) female enrollees who were diagnosed with invasive breast cancer from January 1, 1993, …

A Spatial-Temporal Approach To Surveillance Of Prostate Cancer Disparities In Population Subgroups, Chiehwen Hsu, Francisco Soto Mas, Jerry Miller, Ella Nkhoma

Francisco Soto Mas

BACKGROUND: Prostate cancer mortality disparities exist among racial/ethnic groups in the United States, yet few studies have explored the spatiotemporal trend of the disease burden. To better understand mortality disparities by geographic regions over time, the present study analyzed the geographic variations of prostate cancer mortality by three Texas racial/ethnic groups over a 22-year period.

METHODS: The Spatial Scan Statistic developed by Kulldorff et al was used. Excess mortality was detected using scan windows of 50% and 90% of the study period and a spatial cluster size of 50% of the population at risk. Time trend was analyzed to examine …

P22: The Home Program: Ten Years Of Medical Home Experience In Patients With Developmental Disabilities, Will Lehmann, D Weedon, J Dorius, R Bucciere

Will Lehmann, MD

Thirty-Year Trends (1975-2005) In The Magnitude And Hospital Death Rates Associated With Complete Heart Block In Patients With Acute Myocardial Infarction: A Population-Based Perspective, Hoa Nguyen, Darleen Lessard, Frederick Spencer, Jorge Yarzebski, Juan Zevallos, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: The contemporary magnitude and prognostic implications of complete heart block (CHB) in patients with acute myocardial infarction (AMI) are unknown. As part of a community-based study of patients hospitalized with AMI in the Worcester, MA, metropolitan area, changes over time in the incidence rates of CHB complicating AMI and the prognostic impact of CHB on short-term survival were examined.

METHODS: The study population consisted of 13,663 residents of the Worcester metropolitan area who were hospitalized with AMI at all greater Worcester medical centers during 15 annual periods between 1975 and 2005.

RESULTS: The average age of the hospitalized study …

An Occupational Study Of Physical Playing-Related Injuries In College Music Students, Christine Guptill, Christine Zaza, Stanley Paul

Christine A Guptill

Several studies have been conducted on the playing-related physical injuries of college music students. In this study, a client-centered, occupation-based survey was administered to music majors at a large midwestern university. The primary objectives of the study were to examine which health professionals were consulted by this population, and to determine student satisfaction with any treatment they might have received. Secondary objectives included evaluating students' perceptions of the need for professionals with specialized knowledge of music and musicians, and examining the lifetime prevalence of playing-related injuries in this population. The survey response rate was 92.3% (108/117). Ninety-three respondents (87.7%) of …