When the curtain falls . . .
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Australia↗
Biomedical subjects
John Marley
Publications and source records attributed to John Marley.
Rural origin medical students: how do they cope with the medical school environment?
Australia suffers from a well documented shortage of rural medical practitioners. In an attempt to increase recruitment, it has emerged that rural origin medical students are more than twice as likely as their urban colleagues to become rural practitioners. This has led to a wide range of programs aimed at increasing the number of rural students who apply for and gain entry into medical school. But how do rural students cope with the medical school environment? This paper was based on the results of a survey of senior medical students and looked at how rural students' fare with the medical school environment compared to their urban counterparts. It was concluded that government initiatives currently supporting rural medical students must be continued into the future and continuously evaluated to ensure that rural students have a positive learning experience in preparation for future rural practice.
Adaptation, Psychological↗
Increasing the evidence base for selection for undergraduate medicine: four case studies investigating process and interim outcomes.
INTRODUCTION: Prior to 1997, the University of Adelaide, Australia selected medical students according to matriculation marks alone. After extensive consultation with relevant stakeholders and examination of empirical evidence, the selection process is now based on a national written examination of reasoning and interaction skills, a structured oral assessment and a threshold matriculation score. This paper presents a series of 4 case studies examining the process related to the procedure and early interim outcomes, with the aim of adding to the evidence base for methods of medical student selection. METHODS: Data were collected from a range of sources between 1996 and 2001, including the University's central administration system, the Faculty of Health Sciences, and purpose-designed oral assessment forms and self-report student questionnaires. RESULTS: The oral assessment process has shown itself to be characterised by a high level of interassessor reliability. Equity of access has been addressed and the number of schools represented in the student intake has increased from between 10 and 15 in the final years of the old selection process to over 30 statewide under the new process. There has been a corresponding increase in the proportion of students from rural backgrounds (from an original 4-12% to 20-22%). DISCUSSION: These investigations add to the evidence base for medical school selection in that they demonstrate that an oral assessment process can be reliable and lead to early positive results in relation to student outcomes and access.
Communication↗
Natural history and familial relationships of infant spilling to 9 years of age.
OBJECTIVES: To determine the natural history of infant spilling (regurgitation/vomiting) during the first 2 years of life and to determine the relationship between infant spilling and gastroesophageal reflux (GER) symptoms at 9 years of age. METHODS: A prospective birth cohort was followed with daily symptom diaries during the first 2 years of life and reviewed at 9 years of age (range: 8-11 years). The prevalence of infant spilling during the first 2 years of life, the prevalence of GER symptoms between 8 and 11 years of age (mean age: 9.7 years), relative risk of infant spilling predisposing to GER symptoms at 9 years of age, and prevalence of maternal GER symptoms and relationship with infant spilling and GER at 9 years of age were measured. RESULTS: A total of 693 children who represented 83% of an original sample of 836 children and were followed for 2 years from birth with daily symptom diaries were contacted at 9 (8-11) years of age. Spilling of most feeds each day was common in infancy and reached a peak prevalence of 41% between 3 and 4 months of age and thereafter declined to < 5% between 13 and 14 months of age. Infants with spilling on 90 days or more during the first 2 years of life (classified as frequent spilling) were more likely to have GER symptoms at 9 years of age. Children with frequent infant spilling, compared with those with no spilling, had a relative risk of 2.3 (95% confidence interval [CI]: 1.3-4.0) of 1 or more GER symptoms at 9 years of age, 4.6 (95% CI: 1.5-13.8) for heartburn, 2.7 (95% CI: 1.4-5.5) for vomiting, and 4.7 (95% CI: 1.6-14.0) for acid regurgitation. Gender, breastfeeding, and environmental tobacco smoke exposure were not significant factors related to infant spilling. Prepregnancy smoking and smoking in the same room as the child at the 9-month and 18-month follow-ups had a significant effect on GER symptoms at 9 years of age. Infant spilling and GER at 9 years of age were significantly related to maternal GER symptoms but not to paternal GER symptoms. CONCLUSIONS: Spilling in infancy is very common, but the majority of children settle by 13 to 14 months of age. However, those with frequent spilling (>90 days) are more likely to have GER symptoms at 9 years of age. In addition, a maternal history of GER was significantly related both to infant spilling and to GER at 9 years, suggesting that a genetic component may be involved. Physicians should consider studying children with a history of frequent infant spilling to determine whether this group is at increased risk for GER disease.
Age Factors↗
Effect of changes in antibiotic prescribing on patient outcomes in a community setting: a natural experiment in Australia.
This study examined whether a significant change in antibiotic use caused by an Australian government directive targeted at amoxicillin with clavulanic acid (AC) was associated with changes in prescription share, health care costs, and patient outcomes. We used an integrated database of computerized general practice medical records, which included data regarding 34,242 patients and 318,234 recorded patient visits. There were 15,303 antibiotic prescriptions provided to 9921 patients during a 4-year period, with AC prescribed for 1453 (14.6%) of these patients. A total of 5125 patient outcomes were identified. There was a shift away from best-practice antibiotic prescribing, and a significant association was identified between the rate and cost of process-of-care and patient outcomes and the decrease in AC-prescription share. This policy initiative created unintended changes in prescribing behavior, increased costs to the government, and a trend toward poorer patient outcomes. Detailed analyses are required before instigating initiatives aimed at changing clinicians' prescribing behavior.
Adolescent↗
Abdominal aortic aneurysm: an illustrated narrative review.
OBJECTIVE: To present a descriptive review of abdominal aortic aneurysm (AAA), including a review of risk factors for and case finding in AAA for chiropractors as primary contact health care practitioners. DATA SOURCES: Clinical and scientific literature identified through various sources including MEDLINE and citation tracking. DATA SYNTHESIS: Selective narrative review of relevant literature. RESULTS: AAA may be asymptomatic; however, back pain is a common presenting feature. Risk factors include male gender, increasing age, cigarette smoking, hypertension, chronic obstructive airway disease, claudication, and AAA in a first-degree relative. AAA should be considered in the differential diagnosis of older white patients, especially males, with low back pain. Estimated prevalence for AAAs in older males is in the order of 3% to 5%; rupture accounts for 1.7% of deaths in men aged 65 to 75 years. Elective surgical resection of AAAs (prior to rupture) offers a low operative mortality and good prognosis. CONCLUSION: AAA should be considered in the differential diagnosis of older patients presenting with low back pain and those with risk factors for AAA. Chiropractors, as primary contact health care practitioners, have a responsibility to refer patients suspected of having AAA for appropriate imaging and, where indicated, vascular surgical opinion.
Age Factors↗