K Ogden

A randomised controlled trial of the effects of mindfulness practice on medical student stress levels.

Medical Education 2011: 45: 381–388

Multicenter comparison of processes of care between Stroke Units and conventional care wards in Australia

Background and Purpose— Approximately 23% of Australian hospitals provide Stroke Units (SUs). Evidence suggests that clinical outcomes are better in SUs than with conventional care. Reasons may include greater adherence to processes of care (PoC). The primary hypothesis was that adherence to selected PoC is greater in SUs than in other acute care models. Methods— Prospective, multicenter, single-blinded design. Models of care investigated: SUs, mobile services, and conventional care. Selected PoC were related to care models and participant outcomes. Data were collected at acute hospitalization (median 9 days) and at medians of 8 and 28 weeks after stroke. Results— 1701 patients were screened from 8 hospitals, 823 were eligible, and 468 participated. Response rate was 96% at final follow-up. Mean age was 73 years (SD 14). Overall PoC adherence rates for individual care models were SU 75%, mobile service 65%, and conventional care 52% (P <0.001). The adjusted odds of participants being alive at discharge if adhering to all or all but 1 PoC was significant (aOR 3.63; 95% CI: 1.04 to 12.66; P =0.043). Important trends at 28 weeks were found for being at home (aOR 3.09; 95% CI: 0.96 to 9.87; P =0.058) and independent (aOR 2.61; 95% CI: 0.96 to 7.10; P =0.061), with complete PoC adherence. Conclusion— Adherence to key PoC was higher in SUs than in other models. For all patients, adherence to PoC was associated with improved mortality at discharge and trends found with independence at home, providing support for the need to increase access to stroke units.

Women's maternity care needs and related service models in rural areas: A comprehensive systematic review of qualitative evidence

BACKGROUND Understanding the needs of rural women in maternity care and service models available to them is significant for the development of effective policies and the sustainability of rural communities. Nevertheless, no systematic review of studies addressing these needs has been conducted. OBJECTIVES To synthesise the best available evidence on the experiences of womens needs in maternity care and existing service models in rural areas. METHODS Literature search of ten electronic databases, digital theses, and reference lists of relevant studies applying inclusion/exclusion criteria was conducted. Selected papers were assessed using standardised critical appraisal instruments from JBI-QARI. Data extracted from these studies were synthesised using thematic synthesis. FINDINGS 12 studies met the inclusion criteria. There were three main themes and several sub-themes identified. A comprehensive set of the maternity care expectations of rural women was reported in this review including safety (7), continuity of care (6) and quality of care (6), and informed choices needs (4). In addition, challenges in accessing maternity services also emerged from the literature such as access (6), risk of travelling (9) and associated cost of travel (9). Four models of maternity care examined in the literature were medically led care (5), GP-led care (4), midwifery-led care (7) and home birth (6). CONCLUSION The systematic review demonstrates the importance of including well-conducted qualitative studies in informing the development of evidence-based policies to address womens maternity care needs and inform service models. Synthesising the findings from qualitative studies offers important insight for informing effective public health policy.

Effectiveness and safety of recombinant human bone morphogenetic protein-2 versus local bone graft in primary lumbar interbody fusions.

Study Design. Retrospective cohort study. Objective. To compare clinical outcomes, fusion rates, and rates of complications in posterior lumbar interbody fusions (PLIFs) and transforaminal lumbar interbody fusion procedures with either recombinant human bone morphogenetic protein-2 (rhBMP-2) and local bone graft (LBG) or LBG alone used as graft material. Summary of Background Data. rhBMP-2 is often used in PLIF and transforaminal lumbar interbody fusion procedures, but is associated with complications. Furthermore, recent evidence suggests that using LBG may be sufficient to induce fusion. Methods. All patients who underwent primary interbody fusions under a single surgeon were identified from the surgeons records. In November 2008, the surgeon changed from routinely using LBG to using LBG and rhBMP-2 routinely, limiting selection bias. A retrospective review of prospectively collected data preoperatively and up to 12 months postoperatively was performed. Data collected included visual analogue scale, pain scores for back and leg, Oswestry Disability Index scores, Short-Form 36 (SF-36), standing lumbar radiographs, and clinical notes. Results. Seventy-seven patients met the study criteria and 70 consented to be part of the study. Fifty-one were treated with rhBMP-2 and 19 with LBG. At 12-month follow-up, no significant differences were seen in visual analogue scale score, Oswestry Disability Index score, or SF-36 scores. A total of 89.5% of the LBG group and 94.1% of the rhBMP-2 group went on to show radiographical evidence of fusion by 12-month follow-up (P = 0.61). The rhMBP-2 group had a higher complication rate (41.2% vs. 10.5%, incidence rate ratio = 3.91, P = 0.05). Conclusion. In comparison we found no difference in clinical outcomes, comparable rates of fusion and a significant increase in complication rates with rhBMP-2. Using rhBMP-2 may unnecessarily increase the risk of complication in routine PLIF and transforaminal lumbar interbody fusion procedures. Level of Evidence: 3

Enhancing international medical graduates’ communication: the contribution of applied linguistics

International medical graduates (IMGs) make up one‐third of the Australian medical workforce. Those from non‐English‐language backgrounds can face cultural and communication barriers, yet linguistic support is variable and medical educators are often required to provide feedback on both medical and communication issues. However, some communication difficulties may be very specific to the experiences of IMGs as second language users.

Committing to patient-centred medical education

Regular encounters of patients and medical students in a managed and structured consultation format, to focus on partnership in health care and chronic illness management, can address the student learning and professional development requirements facing contemporary medical education.

Mobile Phones as a Potential Vehicle of Infection in a Hospital Setting

The objective of this article is to investigate the potential role of mobile phones as a reservoir for bacterial colonization and the risk factors for bacterial colonization in a hospital setting. We screened 226 staff members at a regional Australian hospital (146 doctors and 80 medical students) between January 2013 and March 2014. The main outcomes of interest were the types of microorganisms and the amount of contamination of the mobile phones. This study found a high level of bacterial contamination (n = 168/226, 74%) on the mobile phones of staff members in a tertiary hospital, with similar organisms isolated from the staff members dominant hand and mobile phones. While most of the isolated organisms were normal skin flora, a small percentage were potentially pathogenic (n = 12/226, 5%). Being a junior medical staff was found to be a risk factor for heavy microbial growth (OR 4.00, 95% CI 1.54, 10.37). Only 31% (70/226) of our participants reported cleaning their phones routinely, and only 21% (47/226) reported using alcohol containing wipes on their phones. This study demonstrates that mobile phones are potentially vehicles for pathogenic bacteria in a hospital setting. Only a minority of our participants reported cleaning their phones routinely. Disinfection guidelines utilizing alcohol wipes should be developed and implemented.

Mobile phones as a potential vector of infection in a paediatric ward

1 Skinner NA, MacIsaac CM, Hamilton JA, Visvanathan K. Regulation of Toll-like receptor (TLR)2 and TLR4 on CD14dimCD16+ monocytes in response to sepsis-related antigens. Clin. Exp. Immunol. 2005; 141: 270–8. 2 Viemann D, Dubbel G, Schleifenbaum S, Harms E, Sorg C, Roth J. Expression of toll-like receptors in neonatal sepsis. Pediatr. Res. 2005; 58: 654–9. 3 Corbett NP, Blimkie D, Ho KC et al. Ontogeny of Toll-like receptor mediated cytokine responses of human blood mononuclear cells. PLoS ONE 2010; 5: e15041. 4 Imahara SD, Jelacic S, Junker CE, O’Keefe GE. The influence of gender on human innate immunity. Surgery 2005; 138: 275–82.

Research: Why aren’t more medical students doing it?

Background: Many medical schools in Australia and Internationally struggle to engage medical students along a research pathway. Aims: The aim of this study was to identify medical student’s confidence, attitudes and perceived obstacles to participating in research during medical school. Methods: A cross-sectional survey was carried out of undergraduate medical students in years 1–5 attending the University of Tasmania. Results: Of the 237 students who responded to the survey (response rate of 41.9 per cent) the majority (70.3 per cent) agreed that research was a useful experience and expressed a desire to be involved in research (60.1 per cent). Women were generally less confident than men in their ability to conduct research while research experience was significantly associated with an increase in confidence in conducting research. Frequently endorsed reasons by students for not undertaking an Honours year were a desire to not delay graduation by a year for financial (79 per cent) and employment reasons (71 per cent) and social concerns regarding integrating with a different year group (69 per cent). Additional concerns included a lack of time and motivation. Conclusion: The difficulties inherent for students in undertaking research including low confidence, lack of time, financial constraints and pressure to get out into the workforce should help to inform medical educators in developing solutions to encourage student participation in research.

Utility of antenatal clinical factors for prediction of postpartum outcomes in women with gestational diabetes mellitus (GDM)

Gestational diabetes mellitus (GDM) is associated with life‐long increased risk of type 2 diabetes: affected women are advised to undergo oral glucose tolerance testing (OGTT) at 6–12 weeks postpartum, then glucose screening every 1–3 years.