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Biomedical subjects

M K Marks

Publications and source records attributed to M K Marks.

16 recordsLinked to original sources
PubMed2006

Improving medical student performance in smoking health promotion: effect of a vertically integrated curriculum.

The majority of medical schools have curricula that address the health effects of smoking. However, there are many gaps in smoking education, especially in relationship to vertical integration. The authors aimed to determine whether medical students would better address adolescent smoking within a vertically integrated curriculum in comparison with the previous traditional curriculum. They studied two groups of fifth-year students; one group received a specific smoking intervention. Each group consisted of the entire cohort of students within the Child and Adolescent Health rotation of a newly designed medical curriculum. Two groups of students from the previous traditional undergraduate curriculum were available for direct comparison, one of which had received the same teaching on adolescent smoking. An objective structured clinical examination station was used to measure adolescent smoking enquiry. Intervention students in the new curriculum were more likely to enquire about smoking in the objective structured clinical examination than students who did not receive the intervention (p < 0.005). New curriculum students performed better than students from the previous curriculum, whether or not they had received the smoking intervention (p < 0.001). This study suggests that integrated undergraduate teaching can improve student clinical behaviours with regard to opportunistic smoking enquiry in adolescents.

Adolescent↗
PubMed2003

Improving medical student performance in adolescent anti-smoking health promotion.

BACKGROUND: We developed a 1-hour teaching seminar for medical students on anti-smoking health promotion for adolescents. We report the development of the programme and a performance-based evaluation. AIM: To develop a seminar for medical students with the objective of improving medical student inquiry into smoking and the delivery of advice accordingly for adolescent patients in routine consultations. METHOD: The seminar was developed using principles of adult learning and delivered to a cohort of medical students (intervention group). Participants were Year 5 medical students in their paediatrics term. A comparison group of 58 medical students who did not receive the seminar was studied in the semester prior to the intervention. The primary outcome measure was a change in anti-smoking health promotion practice within an objective structured clinical examination (OSCE), where taking a smoking history and making links between smoking status and health were indicated in a 15-year-old simulated patient (SP) with poorly controlled asthma. This was part of the summative assessment in the paediatrics term. RESULTS: In the OSCE, 21 of 58 (36%) students in the comparison group asked the asthmatic SP about smoking, compared with 41 of 56 (73%) students in the intervention group (P = 0.0001). In all, 15 (26%) of the comparison group students addressed the patient's smoking, compared with 33 of the 56 (59%) intervention group students (P = 0.0004). CONCLUSION: A carefully designed seminar addressing adolescent smoking can increase the frequency of smoking inquiry and advice by medical students.

Adolescent↗
PubMed2001

Delayed presentation of an ingested foreign body causing gastric perforation.

Ingested foreign bodies may lead to perforation of the gastrointestinal tract. We present a case of a 14-month-old boy who presented with an unusual abdominal mass secondary to ingesting a foreign body 4 months previously. Abdominal computerized tomography scan was valuable in making this diagnosis.

Foreign Bodies↗
PubMed2001

Successful implementation of spacer treatment guideline for acute asthma.

AIMS: To develop and implement an evidence based guideline for the treatment of acute asthma using a metered dose inhaler and spacer combination. METHODS: Defined strategies were used for the development and implementation of a guideline, assessed by a prospective, descriptive, study using notes review, and patient, nursing, and medical staff telephone contact. The setting was a tertiary referral hospital in Victoria, Australia with 25 000 yearly admissions, and asthma accounting for about 7% of total. The first 200 children and families to use the guideline after its introduction were evaluated. RESULTS: A total of 191 (95.5%) children were treated according to the guideline. Six (3.0%) children were given nebulisers appropriately based on severity; five (2.5%) were given nebulisers at parental or child choice; and four (2.0 %) who did not have severe asthma, received nebulised treatment inappropriately. CONCLUSIONS: Successful implementation of a new evidence based guideline can be achieved using specific strategies for promoting the application of research findings in the clinical arena.

Acute Disease↗
PubMed1999

Asthma: communication between hospital and general practitioners.

OBJECTIVE: To assess whether efforts to actively involve General Practitioners (GPs) in the postdischarge care of their paediatric asthma patients improved their satisfaction with communication with hospital staff. METHODOLOGY: Randomized controlled trial involving 60 patients admitted to the Royal Children's Hospital, Melbourne, with acute asthma and an identifiable GP. The GPs of the intervention patients were telephoned during the admission. Intervention patients and their GPs received printed information detailing the care the patient received in hospital and the recommended postdischarge care, as well as standardized educational booklets about asthma. Follow-up appointments were made for intervention patients to attend their GPs. RESULTS: The GPs of intervention patients were more satisfied when compared to the GPs receiving a standard level of communication (96.4% vs 48.3% of the intervention and control GPs, respectively, described the communication as good or extremely good, P = 0.0001). The intervention group GPs believed they were more involved after discharge (75.0% vs 44.8%, P = 0.005) and had greater understanding of their patient's hospitalisation (96.4% vs 62.1%, P = 0.005). These differences were noted despite there being no difference in the rate of follow-up attendance with GPs for intervention and control patients (85.7% vs 72.4%, P = 0.2). Qualitative data supported these findings with GPs expressing approval of the intervention used. CONCLUSION: Efforts to actively involve GPs in the postdischarge care of their paediatric patients with asthma resulted in a marked improvement in their satisfaction with the communication with medical staff at the Royal Children's Hospital, Melbourne. The study had insufficient power to demonstrate a difference in morbidity.

Aftercare↗
PubMed1997

Intern learning and education in a short stay unit. A qualitative study.

OBJECTIVE: To study interns' perceptions of their learning during their rotation through a short stay unit (SSU). DESIGN: Case-based, qualitative research study. SETTING: A tertiary care pediatric hospital (The Children's Hospital, Boston, Mass). PARTICIPANTS: Ten interns who had worked in the SSU in the 3 months prior to June 1, 1995, and on a general medical team in the previous 12 months. INTERVENTION: None. MAIN OUTCOME MEASURES: In July 1995, the interns participated in focused, open-ended interviews lasting about 40 to 60 minutes to document their perceptions of their learning during their SSU rotation. The interviews were recorded on audiotape and transcribed prior to analysis. Data were analyzed to discern and categorize themes from the interns' responses. RESULTS: All interns responded favorably to their educational and learning experiences during their rotation through the SSU. Two major themes emerged: (1) the interns' learning, which was affected by the role of the attending physician, the organization and structure of the SSU, and the teaching strategies in the SSU; and (2) the interns' collaborative work with the nursing staff in the SSU, which affected patient care but did not facilitate the interns' learning. CONCLUSION: Clustering in the SSU of patients whose symptoms suggested straightforward diagnoses enhanced interns' educational experiences.

Adult↗
PubMed1997

Impact of a short stay unit on asthma patients admitted to a tertiary pediatric hospital.

A short stay unit (SSU) was opened at the Children's Hospital, Boston, with the aim of better fulfilling the needs of pediatric patients with straightforward diagnoses. Using historical and simultaneous comparison groups and controlling for disease severity, the opening of the SSU led to a decrease of between 16.5 and 28.4 percent in the mean length of stay for asthma patients without any increase in the rate of hospital readmission.

Acute Disease↗
PubMed1997

Digital video image capture in establishing positive identification.

Positive identification of skeletonized, decomposed, or disfigured victims lacking clinical records is a difficult endeavor. However, videotapes of family and social activities can be analyzed using the frame isolating technique of video image capture by inexpensive means. A rare skeletal Class III malocclusion and dental peculiarities in a decomposing 3-year old lacking a clinical history were compared to videotapes taken of a suspected victim shortly prior to her disappearance. Overlaying transparent dental tracings from digitized skeletal remains onto selected frames of the videotape (and reversing this process) produced the identification and hastened the entire investigation.

Child, Preschool↗
PubMed1995

Measurement of respiratory rate and timing using a nasal thermocouple.

OBJECTIVE: The aims of this study were to assess aspects of the response of a small thermocouple to temperature change, and to evaluate whether such a thermocouple could be used intermittently to measure respiratory rate and timing by detecting the changes in nasal temperature occurring with breathing. METHODS: The study had three parts. First, three similar, fast-responding thermocouples were immersed repeatedly in warm water. Second, the influence of atmospheric temperature on the signal of a thermocouple placed at different sites within the nasal orifice was studied. The signals produced were continuously displayed and analyzed using a laptop computer to allow evaluation of the thermocouples' response characteristics. Third, simultaneous respiratory recordings were acquired using a nasal thermocouple and a nasal pneumotachograph in 12 teenaged subjects. The respiratory rate and the periods of time taken for inspiration (Ti) and expiration (Te) were calculated and compared. RESULTS: The thermocouples' responses to the temperature changes associated with breathing and immersion into water were rapid and consistent. The rate of the signals' decay, following the peak signal marking expiration, was influenced by the atmospheric temperature. The time constants of the thermocouples were similar (mean time constant = 0.41 sec, standard deviation (SD) = 0.07). Optimal respiratory recordings were obtained, with least discomfort, when the thermocouple was positioned at 0 to 4 mm within the nasal orifice. In comparing the respiratory recordings acquired simultaneously with a thermocouple and pneumotachograph, the respiratory rates were identical, and the Ti and Te values were similar (mean difference 0.04 sec (95% CI: -0.11 to 0.21 sec) and -0.04 sec (95% CI: -0.20 to 0.12 sec), respectively). CONCLUSIONS: Intermittent measurements of respiratory rate and timing using a nasal thermocouple accurately reflected measurements obtained from nasal airflow using a pneumotachograph.

Adolescent↗
PubMed1993

Reference ranges for respiratory rate measured by thermistry (12-84 months).

Previous studies of respiratory rate in children have had a number of methodological problems. The aim of this study was to construct age specific reference ranges for respiratory rate. Respiratory rate in children attending childcare centres, kindergartens, and schools was measured using a nasal thermocouple to obtain respiratory waveforms. Reference ranges were constructed using data from 293 awake children between 12 and 84 months, and from 123 sleeping children between 12 and 60 months. The mean respiratory rate declined with increasing age and was significantly lower, with lower variability, during sleep than wakefulness. Neither the awake nor sleeping reference ranges were significantly affected by sex, nor by the presence of past respiratory nor current respiratory symptoms.

Age Factors↗
PubMed1988

Infantile myofibromatosis causing biliary and pancreatic obstruction: a case report.

A case of obstructive jaundice caused by a solitary myofibroma in an 18-week-old infant is presented. Preoperative investigations demonstrated total biliary and partial pancreatic obstruction, although no obstructing lesion was identified radiologically. At operation a 3-cm solitary myofibroma was found in the head of the pancreas. Because of the morbidity associated with resection at this site, a bypass procedure was performed in the hope that the lesion will regress.

Cholestasis↗
PubMedDate not supplied

Updating asthma management: the process of change.

A strategic approach to changing clinical practice that is managed by a multidisciplinary team is an effective way of implementing new treatment methods or approaches to patient care. The Royal Children's Hospital, Melbourne, Australia, a tertiary pediatric hospital, instituted new Asthma Delivery Device Guidelines in recognition of current evidence that described the benefits of treating acute pediatric asthma with pressurized metered dose inhalers and spacer devices. The working group that coordinated the project attributes the successful change in practice to a multifaceted, multidisciplinary approach, a significant planning stage, initial and ongoing intensive staff and patient/parent education, and accessibility of information.

Asthma↗
PubMedDate not supplied

Fever in a returned traveller.

An 8-year-old boy, presenting with fever after returning from a visit to Papua New Guinea, was found to have typhoid, despite immunization against this disease prior to travel. This most likely represented vaccine failure, although it is also possible that he acquired the infection from overseas visitors who had stayed with his family prior to his travel, or that he contracted the disease from his father. This case highlights the importance of considering typhoid as a cause of fever in a returned traveller, even if they have been previously immunized against this disease. It also highlights that, in addition to taking the patient's travel history, information should be specifically sought about contact with visitors from overseas and the travel history of other household members.

Anti-Bacterial Agents↗
PubMedDate not supplied

Cerebral palsy: what do medical students know and believe?

OBJECTIVES: Negative attitudes toward people with disabilities, including cerebral palsy, may be related to misunderstandings or lack of knowledge about the disability. If held by medical practitioners, they can have detrimental implications for the care of people with disabilities. The purposes of this study were to examine the knowledge and attitudes of medical students regarding cerebral palsy and to examine the effects of the videotape 'Understanding Cerebral Palsy' on these two areas. METHODS: The attitudes and knowledge regarding cerebral palsy of 54 medical students in their penultimate year were measured before and after watching a video produced to educate health professionals about cerebral palsy. They were assessed using a self-administered questionnaire constructed specifically for the study, adapted from previously validated questionnaires. RESULTS: These medical students generally had limited knowledge about cerebral palsy and displayed negative attitudes toward people with cerebral palsy. It was also found that males had less positive attitudes than females (P = 0.014) and that students educated mainly in Asia had less positive attitudes than students educated mainly in Australia (P = 0.012). The videotape was shown to be effective in improving the students' knowledge about cerebral palsy. A small but significant improvement in attitudes was also shown (P = 0.014), with the attitudes of some students improving dramatically. However, negative attitudes remained in many. CONCLUSIONS: Based on the findings, structured teaching about cerebral palsy is necessary within the medical curriculum at the University of Melbourne. Greater promotion of positive attitudes toward people with cerebral palsy and other disabilities is required.

Cerebral Palsy↗
PubMedDate not supplied

Intended management of children with acute idiopathic thrombocytopenic purpura: a national survey.

OBJECTIVE: In Australia acute idiopathic thrombocytopenic purpura (ITP) is mainly treated by paediatricians (either general paediatricians or paediatric haematologists/oncologists). A survey was conducted to gauge the current practice of treating children with acute ITP in Australia. METHODS: All practising Australian paediatricians registered by the Royal Australasian College of Physicians were surveyed regarding their intended management of children with acute ITP. The questionnaire, adapted from a study of paediatric haematologists/oncologists in North America, presented four clinical scenarios of children with acute ITP with a platelet count of 3000 x 10(9)/L, with and without mucosal bleeding (wet and dry purpura, respectively). Questionnaires were returned by mail or filled in online at a dedicated webpage. RESULTS: Five hundred and sixty-three of 1097 (51%) paediatricians responded to the survey. Data from 140 who had treated at least one child with ITP in the previous 12 months were analysed. Respondents indicated that children with acute ITP are usually or always hospitalised (58-92%) and that 48% would be given active treatment, even with dry purpura. Various regimens of i.v. immunoglobulin or corticosteroids are used when treatment is administered. In comparing Australian and North American management of acute ITP there were many similarities, although Australian paediatricians were less likely to arrange a bone marrow aspirate if corticosteroids were prescribed. CONCLUSIONS: There is great variation in the intended management of children with acute ITP in Australia. Previously published management recommendations regarding investigation and treatment have had little impact on intended practice. Prospective studies are required to evaluate hypotheses so as to produce evidence-based recommendations for treatment of patients with acute ITP.

Acute Disease↗