One of the major challenges in primary prevention of stroke stems from the need to accurately identify the at-risk group from seemingly healthy participants....]]>
To descriptively assess medical students’ concerns for their mental and emotional state, perceived need to conceal mental problems, perceived level of support at university, knowledge and use of student support services, and experience of stresses of daily life.
From March to September 2011, medical students at an Australian university were invited to complete an anonymous online survey.
475 responses were received. Students rated study and examinations (48.9%), financial concerns (38.1%), isolation (19.4%) and relationship concerns (19.2%) as very or extremely stressful issues. Knowledge of available support services was high, with 90.8% indicating they were aware of the university's medical centre. Treatment rates were modest (31.7%). Students’ concerns about their mental state were generally low, but one in five strongly felt they needed to conceal their emotional problems.
Despite widespread awareness of appropriate support services, a large proportion of students felt they needed to conceal mental and emotional problems. Overall treatment rates for students who were greatly concerned about their mental and emotional state appeared modest, and, although comparable with those of similarly aged community populations, may reflect undertreatment. It would be appropriate for universities to address stressors identified by students. Strategies for encouraging distressed students to obtain appropriate assessment and treatment should also be explored. Those students who do seek healthcare are most likely to see a primary care physician, suggesting an important screening role for these health professionals.
To investigate the variation in the net ingredient cost (NIC) of the medications most commonly prescribed by Foundation Year 1 (F1) doctors in a teaching hospital and to compare the effects of working in different specialties and rotations on this cost.
Retrospective review of prescription data from 5 August 2010 to 3 August 2011 extracted from an electronic prescribing system.
The F1 doctors generated 81 316 prescriptions with an estimated total cost of £579 398. The mean NIC per doctor was £7334 (SE=£430). Prescribing costs varied significantly across clinical departments and between drug classes considered in the analysis. Specifically, prescribing in the infection and respiratory drug categories and within the trauma and orthopaedics department was associated with higher prescribing costs. Significant variability was also attributable to the prescribing doctor (p<0.001) with average prescription costs ranging from 72.2% lower to 193.8% higher than the median doctor.
There is considerable variation in the total costs of medications prescribed by F1 doctors, even after considering a range of prescription factors. This variation may suggest that some doctors are prescribing uneconomically relative to the rest of the cohort. Knowledge of which clinical areas and drug classes have higher NICs may allow an alternative focus for medicine management teams and postgraduate education.
There is lack of contemporary outcome data on patients with hospital-acquired infections that cause bacteraemia. We determined the risk factors for 7-day mortality and investigated the hypothesis that, compared with central venous catheter (CVC)-associated bacteraemic infections, catheter-associated bacteraemic urinary tract infections (UTIs) were significantly associated with 7-day mortality.
From October 2007 to September 2008, demographical, clinical and microbiological data were collected on patients with hospital-acquired bacteraemia. Patients were followed until death, hospital discharge or recovery from infection. Risk factors for 7-day mortality were determined and multivariate logistic regression was used to define the association between catheter-associated bacteraemic UTIs and likelihood of death.
559 bacteraemic episodes occurred in 437 patients. Overall, there were 90 deaths (20.6%) at 7 days and 153 deaths (35.0%) at 30 days. Among patients with catheter-associated bacteraemic UTIs, 7-day and 30-day mortalities associated with each bacteraemic episode were 25/83 (30.1%) and 33/83 (39.8%), respectively. Within this subgroup, the commonest isolates were Escherichia coli, 36 (43.4%), Proteus mirabilis, 11 (13.3%) and Pseudomonas aeruginosa, 9 (10.8%). There were 22 (26.5%) multiple drug-resistant isolates and, of the E coli infections, 6 (16.7%) were extended spectrum β-lactamase producers. In univariate analysis, the variables found to have the strongest association with 7-day mortality were age, Pitt score, Charlson comorbidity index (CCI), medical speciality and site of infection. Compared with CVC-associated bacteraemic infections, there was a significant association between catheter-associated bacteraemic UTIs and 7-day mortality (OR 4.16, 95% CI 1.86 to 9.33). After adjustment for age and CCI, this association remained significant (OR 2.90, 95% CI 1.19 to 7.07).
Compared with CVC-associated bacteraemic infections, catheter-associated bacteraemic UTIs were significantly associated with 7-day mortality. Efforts to reduce these infections should be prioritised.
Achieving target door–needle times for ST elevation myocardial infarction remains challenging. Data on emergency department (ED) doctor-led thrombolysis in developing countries and factors causing delay are limited.
To assess the effect on door–needle times by transferring responsibility for thrombolysis to the ED doctors and to identify predictors of prolonged door–needle times.
Data on medical on-call team-led thrombolysis at a tertiary Asian hospital were prospectively collected from May 2007 to Aug 2008 (1st study period). In September 2008, ED doctors were empowered to perform thrombolysis. The practice change was accompanied by new guidelines, tick chart implementation, and training sessions. Data were then consecutively collected from September 2008 to May 2009 (2nd study period). Door-to-needle times for the 1st and 2nd study periods were compared. All cases were analysed for factors of delay by multiple logistic regression.
297 patients were thrombolysed, 169 by the medical on-call team during the 1st study period and 128 by the ED doctors during the 2nd study period. Median door–needle times were 54 and 48 min, respectively (p=0.76). Significant delays were predicted by ‘incorrect initial ECG interpretation’ (adjusted OR (aOR) 14.3), ‘inappropriate triage’ (aOR 10.4) and ‘multiple referrals’ (aOR 5.9). No cases of inappropriate thrombolysis were recorded.
Transfer of responsibility for thrombolysis to the ED doctors did not improve door–needle times despite measures introduced to facilitate this change. Key causative factors for this failure were identified.
Splenosis represents the deposition of viable splenic tissue in a different anatomic compartment, usually following trauma. The extent of deposition is related to the severity of trauma and amount of pulp tissue released into the abdominal and pelvic cavities. Thoracic splenosis, is the deposition of splenic tissue within the thoracic cavity and occurs in about 18% of cases.
A 42-year-old male smoker presented with abdominal pain. A CT abdomen and chest showed calcified pleural thickening, old left rib fractures, and several lung nodules (majority pleural, positron emission tomography negative) (
Pinto A, Faiz O, Vincent C. Republished: Managing the after effects of serious patient safety incidents in the NHS: an online survey study. Postgrad Med J 2013;89:266–273.
In the abstract, under Results, the sentence "two-thirds of the discussions taking place 3–6 weeks after the investigation" should read "two-thirds of the discussions taking place 3–6 months after the investigation". Also in the main text, under the results, the sentence "two-thirds take place 3–6 weeks after the investigation" should read "two-thirds take place 3–6 months after the investigation".
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