Transferability of faculty development resources.

BACKGROUND: Adapting existing training resources for clinical teachers is more efficient than creating resources de novo. There is limited evidence on how to effectively use and ensure the relevance of training materials originally developed for different contexts and audiences. We tested in Sri Lanka and Malaysia the transferability of scenario-based training videos and session plans developed for Australian medical schools, to identify those aspects which need adaptation, and make recommendations to enhance transferability. METHODS: Staff involved in student support from three medical schools were invited to participate in five workshops facilitated by an Australian educator. Video discussion triggers of students presenting with concerns were used in workshop activities, including written exercises, group discussions and reflection. The quantitative and qualitative data collected included categorical and free-text participant responses to questionnaires and structured field notes from local faculty developers using peer observation. FINDINGS: Academic and clinician-teacher participants predominated in the workshops. Of 66 participant questionnaires (92% response rate), over 90% agreed that the workshop was relevant, and over 95% agreed that the videos facilitated discussion and the sharing of experiences. Field notes confirmed that participants were engaged by the videos, but identified that one student scenario and the approaches for seeking support in others were not immediately transferable to local contexts. The adaptation of facilitation techniques used in Australian workshops was needed to address audience responses. DISCUSSION: Our findings confirm faculty development principles of content relevancy and incorporation of reflection. To enhance transferability, we recommend co-facilitation with local faculty members, the explicit signposting of topics and re-contextualising key concepts through reflective discussion.

Fit4YAMs: Structuring a Lifestyle Intervention for Rural Overweight and Obese Young Adult Males Using Participatory Design.

PURPOSE: Young adult males (YAMs) are understudied with respect to lifestyle interventions to address overweight and obesity in this group. This study reports on the participatory design of the structure and delivery of the Fit4YAMs text message-based lifestyle intervention for 18- to 25-year-old rural YAMs in Australia. METHODS: Two semi-structured focus group discussions were held with six overweight or obese YAMs. Sessions explored their preferences for the structure and delivery of a weight loss intervention. Focus groups were recorded, and the contents transcribed verbatim for thematic analysis. RESULTS: The YAMs were unanimous in their preference for a highly personalized intervention program, complete with personalized goal setting, personalized motivation and engagement strategies, and personalized text message content. A text message frequency of three-four messages per week was deemed optimal for this group. Minimal direct contact by the intervention team was requested, but with clear guidelines and reminders of key contacts whom they could contact should they require help and guidance. The YAMs also agreed that a comprehensive goal setting session and personalization session prior to commencement of the intervention would be best. CONCLUSIONS: To engage rural YAMs in lifestyle interventions, a high degree of personalization of the program appears important. Although initially more time and resource intensive than a less personalized approach, it is essential to identify strategies to prevent and reverse weight gain in this hard to engage group. Maximizing their engagement using a more personalized approach could be the key to promoting long-term health outcomes in this group.

2014 Rural Clinical School Training and Support Program Snapshot survey.

INTRODUCTION: The Rural Clinical Training and Support (RCTS) program is an Australian Government initiative to address the shortage of medical practitioners within rural and remote Australia. There is a large amount of published information about the RCTS program and rural medical student cohorts who have undertaken short- and long-term rotations. However, very little is known about the academic and professional staff involved in the program, a knowledge gap that may impact workforce and succession planning. To address this, the Federation of Rural Australian Medical Educators (FRAME) initiated the pilot 2014 RCTS Snapshot survey to obtain data on the current RCTS workforce. METHODS: All professional, academic and clinical academic staff (fixed-term and continuing, regardless of fraction) employed through the RCTS program were invited to complete a short, web-based survey. The survey was conducted from March to June 2014. The quantitative variables in the survey included demographics (age and gender), rural background and exposure, employment history in rural/regional areas and at rural clinical schools (RCS), experience and expertise, reasons for working at RCS, and future employment intentions. The last three questions also were of a qualitative open-ended format to allow respondents to provide additional details regarding their reasons for working at RCSs and their future intentions. RESULTS: The estimated total RCTS workforce was 970. A total of 413 responses were received and 316 (40.9%) complete responses analysed. The majority of respondents were female (71%), the 40-60-year age group was predominant (28%), and professional staff constituted the majority (62%). The below 40-year age group had more professionals than academics (21% vs 12%) and more than 62% of academics were aged above 50 years. Notably, there were no academics aged less than 30 years. The percentage of professional staff with a rural background was higher (62%) than that of academics with a rural background (42%). However, more than 70% of academics had previous exposure to a rural area as an adult and 32% had an exposure as a part of university or the TAFE (technical and further education) system. More than half (62%) of RCTS academics were aged more than 50 years and thus approaching retirement age. The implementation of a FRAME-sponsored leadership and succession program was considered by most staff (84%) as one strategy that could be used to prevent a future shortage of academics. Lifestyle reasons for working at an RCS were common to both academic (54%) and professional (63%) staff. A passion for rural health and building capacity within the rural health workforce were other central themes to emerge from the qualitative data. Uncertainty around contract renewal and future funding were dominant themes to emerge from respondents regarding their future employment intentions within the RCTS program. CONCLUSIONS: This study has provided valuable insights into the professional and academic staff's views and aspirations about the RCTS program. These data on the current RCTS workforce provide a benchmark to which future surveys of the workforce can be compared to monitor trends in turnover or predict future shortages due to cohort ageing.

A decade of Rural Clinical School research: a PubMed review.

INTRODUCTION: One parameter of the operational framework of the Australian Rural Clinical Training & Support Program (RCTS) is rural health research, yet there are no published reports of the research outcomes generated by these hallmarks of Australian rural medical education. To assess the contribution of RCTS to rural health research, their MEDLINE-indexed research publications over the last decade was analysed, using a bibliometric method. METHODS: MEDLINE-indexed RCTS publications from 2004 to 2013 were retrieved using validated PubMed queries. Two authors independently checked all retrieved RCTS publications for validity. Australian rural health (ARH) publications from RCTS were selectively enumerated and their proportion among all Australian rural health publications in each year was determined. ARH publications were defined as Australian publications that explore issues relevant to the health of the regional, rural or remote Australian population.RCTS publications related to medical education, Indigenous health, rural service areas, National Health Priority Areas (NHPA), and National Rural Health Alliance Priority Areas (NRHAPA) were analysed. Frequency of publication in different journals was also compared. RESULTS: A total of 280 RCTS publications were retrieved, increasing from 10 in 2004 to 49 in 2013. ARH topics dominated (177 articles; 67%). RCTS rural health publications increased as a proportion of all ARH publications from 3.4% in 2004 to 7.7% in 2013. Other RCTS publications increased from 2 (20% of total) in 2004 to 19 (39% of total) in 2013, and covered topics such as mental health, cancer, diabetes, obesity and asthma. RCTS medical education publications increased from 3 in 2004 to 14 in 2013. In total, 81 articles were retrieved comprising 28.9% of all RCTS publications. Indigenous health (18; 6%), rural populations (37; 13%) and rural health services (83; 29%) were the other important categories relevant to the RCTS funding parameters. RCTS publications also included NHPA (57; 20%) and NRHAPA (61; 22%). The main journals publishing RCTS research in this time period were Rural and Remote Health (16%), Australian Journal of Rural Health (13%) and Australian Family Physician (9%). RESULTS: This first study to report on the research efforts of RCTS researchers has shown that they are making a valuable contribution to rural health research and increasingly so within the research parameters indicated. These data represent a benchmark of research strengths and highlight research areas that should be strengthened with targeted research to best promote the health of rural Australians.

Antibiotic use for Vibrio infections: important insights from surveillance data.

BACKGROUND: There is a paucity of data on the in vivo efficacy of antibiotics for lethal Vibrio species. Analyses of long-term surveillance datasets may provide insights into use of antibiotics to decrease mortality. METHODS: The United States Centers for Disease Control and Prevention (CDC) Cholera and Other Vibrio Illness Surveillance (COVIS) dataset from 1990 to 2010, with 8056 records, was analysed to ascertain trends in antibiotics use and mortality. RESULTS: Two-thirds of patients (5243) were prescribed antibiotics - quinolones (56.1 %), cephalosporins (24.1 %), tetracyclines (23.5 %), and penicillins (15.4 %). Considering all Vibrio species, the only class of antibiotic associated with reduced odds of mortality was quinolone (odds ratio 0.56, 95 % CI 0.46-0.67). Patients with V. vulnificus treated according to CDC recommendations had lower mortality (quinolone alone: 16.7 %, 95 % CI 10.2-26.1; tetracycline plus cephalosporin: 21.7 %, 16.8-27.5; no antibiotic: 51.1 %, 45.6-56.7; each p < 0.001). Cephalosporin alone was associated with higher mortality (36.8 %, 28.2-46.3). For V. cholerae non-O1, non-O139, mortality rates were lower for quinolone (0 %, 0-2.0) or tetracycline (4.3 %, 1.2-14.5) compared to no antibiotic (9.3 %, 6.4-13.3). For all Vibrio species, mortality rates increased with number of antibiotics in the treatment regimen (p < 0.001). Treatment regimens that included quinolone were associated with lower mortality rates regardless of the number of antibiotics used. The main clinical syndromes of patients with V. vulnificus infection were septicaemia (53.1 %) and wound infections (30.6 %). Mortality among V. vulnificus patients with septicaemia was significantly higher than for other clinical syndromes (p < 0.001). In a multivariate regression model, mortality in cases with V. vulnificus was associated with presence of pre-existing conditions (ORs ranged from 4.52 to 10.30), septicaemia (OR 2.64, 95 % CI 1.92-3.63) and no antibiotic treatment (OR 7.89, 95 % CI 3.94-15.80). CONCLUSION: In view of the lack of randomized control trials, surveillance data may inform treatment decisions for potentially lethal Vibriosis. Considering all Vibrio species, use of quinolones is associated with lower mortality and penicillin alone is not particularly effective. For the most lethal species, V. vulnificus, treatment that includes either quinolone or tetracycline is associated with lower mortality than cephalosporin alone. We recommend treating patients who present with a clinical syndrome suggestive of V. vulnificus infection with a treatment regimen that includes a quinolone.

Tracking Australian health and medical research expenditure with a PubMed bibliometric method.

OBJECTIVE: To assess Australian health and medical research (HMR) investment returns by measuring the trends in HMR expenditure and PubMed publications by Australian authors. METHODS: Bibliometric analysis collating Australian HMR expenditure reported by the Australian Institute of Health and Welfare and Australian HMR publications indexed in PubMed. Similar methods were applied to data from the United Kingdom and New Zealand. RESULTS: From financial year 2000/01 through 2011/12, HMR investment increased by 232% from $1.49 to $4.94 billion (current prices adjusted for inflation), while PubMed publications increased by 123% from 10,696 to 23,818. The average HMR investment required for a single PubMed publication rose by 49% from $139,304 in 2000/01 to $207,364 in 2011/12. Quality analyses showed an increase in systematic reviews, cohort studies and clinical trials, and a decrease in publications in PubMed's core clinical journal collection. Comparisons with New Zealand and the United Kingdom showed that Australia has had the greatest overall percentage increase in gross publication numbers and publications per capita. CONCLUSIONS: Our analyses confirm that increased HMR expenditure is associated with an increase in HMR publications in PubMed. IMPLICATIONS: Tracking HMR investment outcomes using this method could be useful for future policy and funding decisions at a federal and specific institution level.

Bibliometric analysis on Australian rural health publications from 2006 to 2012.

OBJECTIVE: To review Australian rural health (ARH) publications in PubMed from 2006 to 2012 and address ARH issues raised by the 2013 Health and Medical Research report. DESIGN: Retrospective observational study. SETTING: Internet-based bibliometric analysis using PubMed. MEDLINE-indexed ARH publications from 2006 to 2012 were retrieved using PubMed queries. ARH publications were defined as Australian publications that explore issues relevant to the health of the regional, rural or remote Australian population. Two authors independently reviewed a random sample of 5% of publications for validity. MAIN OUTCOME MEASURES: Analysis determined country of origin (Australia); publications relevant to the National Health Priority Areas, the 2013 National Rural Health Alliance priority areas and Rural Clinical Schools/University Departments of Rural Health; and journal frequencies and publication types. RESULTS: ARH publications increased from 286 in 2006 to 393 in 2012 and made up 1.4% of all Australian PubMed publications. Combined, the health priority areas were addressed in 52% of ARH publications. Rural Clinical Schools/University Departments of Rural Health articles made up 7% of ARH publications. An increase in cohort studies, systematic reviews and reviews indicated improved quality of articles. ARH articles were most commonly published in the Australian Journal of Rural Health (15.9%), Rural and Remote Health (13.4%) and the Medical Journal of Australia (6.3%). Striking a balance between broadening the queries (increasing sensitivity) and limiting the false positives by restricting the breadth of the queries (increasing specificity) was the main limitation. CONCLUSIONS: This reproducible analysis, repeated at given timelines, can track the progress of ARH publications and provide directions regarding future rural health research.

Large and forgotten in rural Australia: assessment, attitudes and possible approaches to losing weight in young adult males.

BACKGROUND: Young Adult Males (YAMs) in rural Australia are poorly studied with respect to overweight and obesity. Firstly, we explored the feasibility of recruiting 17-25 year old YAMs to obtain baseline data on overweight and obesity rates, socio-demographics, nutrition, exercise and mobile phone usage. Secondly, we explored the views of YAMs with a waist measurement over 94 cm about using mobile phone text messages to promote weight loss and incentives to promote healthy lifestyles. METHODS: A two-staged, mixed-methods approach was used to study obesity and overweight issues in Dubbo, a regional city in New South Wales, Australia. In Phase I, socio-demographic, health behaviour and mobile phone usage data were collected using a questionnaire and anthropometric data collected by direct measurement. In Phase II, YAMs' views were explored by focus group discussion using a semi-structured questionnaire. RESULTS: Phase I (145 participants): mean Body Mass Index (BMI) 25.06±5.01; mean waist circumference 87.4±15.4 cm. In total, 39.3% were obese (12.4%) or overweight (26.9%) and 24.1% had an increased risk of metabolic complications associated with obesity. 135 (93.1%) owned a mobile phone and sent on average 17±25 text messages per day and received 18±24. Phase II (30 participants): YAMs acknowledged that overweight and obesity was a growing societal concern with many health related implications, but didn't feel this was something that affected them personally at this stage of their lives. Motivation was therefore an issue. YAMs admitted that they would only be concerned about losing weight if something drastic occurred in their lives. Text messages would encourage and motivate them to adopt a healthy lifestyle if they were individually tailored. Gym memberships, not cash payments, seem to be the most favoured incentive. CONCLUSION: There is a clear need for an effective health promotion strategy for the almost 40% overweight or obese Dubbo YAMs. The high rate of text message usage makes it feasible to recruit YAMs for a prospective study in which personalized text messages are used to promote healthy behaviours. It may be important to target motivation specifically in any weight-related intervention in this group with incentives such as gym membership vouchers.

Endotracheal tube cuff pressure before, during, and after fixed-wing air medical retrieval.

Abstract Background. Increased endotracheal tube (ETT) cuff pressure is associated with compromised tracheal mucosal perfusion and injuries. No published data are available for Australia on pressures in the fixed-wing air medical retrieval setting. Objective. After introduction of a cuff pressure manometer (Mallinckrodt, Hennef, Germany) at the Royal Flying Doctor Service (RFDS) Base in Dubbo, New South Wales (NSW), Australia, we assessed the prevalence of increased cuff pressures before, during, and after air medical retrieval. Methods. This was a retrospective audit in 35 ventilated patients during fixed-wing retrievals by the RFDS in NSW, Australia. Explicit chart review of ventilated patients was performed for cuff pressures and changes during medical retrievals with pressurized aircrafts. Pearson correlation was calculated to determine the relation of ascent and ETT cuff pressure change from ground to flight level. Results. The mean (± standard deviation) of the first ETT cuff pressure measurement on the ground was 44 ± 20 cmH2O. Prior to retrieval in 11 patients, the ETT cuff pressure was >30 cmH2O and in 11 patients >50 cmH2O. After ascent to cruising altitude, the cuff pressure was >30 cmH2O in 22 patients and >50 cmH2O in eight patients. The cuff pressure was reduced 1) in 72% of cases prior to take off and 2) in 85% of cases during flight, and 3) after landing, the cuff pressure increased in 85% of cases. The correlation between ascent in cabin altitude and ETT cuff pressure was r = 0.3901, p = 0.0205. Conclusions. The high prevalence of excessive cuff pressures during air medical retrieval can be avoided by the use of cuff pressure manometers. Key words: cuff pressure; air medical retrieval; prehospital.

A bibliometric analysis of Australian general practice publications from 1980 to 2007 using PubMed.

BACKGROUND: We analysed Australian general practice (GP) publications in PubMed from 1980 to 2007 to determine journals, authors, publication types, national health priority areas (NHPA) and compared the results with those from three specialties (public health, cardiology and medical informatics) and two countries (the UK and New Zealand). METHOD: Australian GP publications were downloaded in MEDLINE format using PubMed queries and were written to a Microsoft Access database using a software application. Search Query Language and online PubMed queries were used for further analysis. RESULTS: There were 4777 publications from 1980 to 2007. Australian Family Physician (38.1%) and the Medical Journal of Australia (17.6%) contributed 55.7% of publications. Reviews (12.7%), letters (6.6%), clinical trials (6.5%) and systematic reviews (5%) were the main PubMed publication types. Thirty five percent of publications addressed National Health Priority Areas with material on mental health (13.7%), neoplasms (6.5%) and cardiovascular conditions (5.9%). The comparable numbers of publications for the three specialties were: public health - 80 911, cardiology - 15 130 and medical informatics - 3338; total country GP comparisons were: UK - 14 658 and New Zealand - 1111. DISCUSSION: Australian GP publications have shown an impressive growth from 1980 to 2007 with a 15-fold increase. This increase may be due in part to the actions of the Australian government over the past decade to financially support research in primary care, as well as the maturing of academic general practice. This analysis can assist governments, researchers, policy makers and others to target resources so that further developments can be encouraged, supported and monitored.

A ten-year retrospective study of unplanned hospital readmissions to a regional Australian hospital.

OBJECTIVE: To examine the trend in unplanned readmissions (URs) to Dubbo Base Hospital (DBH) over the period 1996-2005 and assess possible correlations with basic demographic data. RESULTS: URs increased over the study period, both as a total number and as a proportion of total admissions (from 4.7 to 5.4%), while average length of stay decreased from 5.3 to 4.4 days and available hospital beds decreased from 156 to 116. The proportion of URs for people aged 75 years has more than doubled over the same period. There were clear temporal variations in URs (greatest number occurring on Fridays and in late winter/early spring) and variations with age and gender (greatest number in young males; peaks for males in 0-10 and 71-80-year deciles and for females in 0-10, 21-30 and 71-80 year deciles). Fifty percent of URs occurred within 7 days of discharge. There was a statistically significant but small correlation between length of prior admission and time to readmission (Spearman correlation coefficient, 0.068; P < 0.01) although the time to readmission did not change over the study period. Chronic obstructive pulmonary disease (3.8%), complications of procedures (3.6%), heart failure and pneumonia (each 2.2%), angina (2.1%) and acute bronchiolitis (1.8%) were the top causes of URs. CONCLUSION: URs are becoming more frequent in DBH; analysis of associations and trends over time are the first step in determining targeted measures to address the problem.

Retrospective bibliometric review of rural health research: Australia's contribution and other trends.

INTRODUCTION: The health of half of the world's 6 billion people and of the 6 million Australians living in rural and remote communities is demonstrably poorer than that of their metropolitan counterparts. As the existence of the discrete specialty of rural health (RH) is gaining acceptability worldwide, publications about RH issues are increasing in prevalence. We undertook a bibliometric analysis of Australian rural research trends and compared these with international RH research output, and analyzed how Australian RH research has been addressing the National Health Priority Areas (NHPAs) during this period. METHODS: Medline-listed publications from 1990 to 2005 relating to rural health or rural health services were downloaded using PubMed and written to a Microsoft Access database using specially developed software. Analysis was performed to determine the country of origin of the authors, frequency of journals, publication types and how publications addressed Australian NHPAs. RESULTS: We retrieved 20 913 rural health publications of which 1442 (6.8%) were from Australia. Analysis from 1990 and 2005 showed total world yearly publications increased from 410 to 1207, while the respective contribution from Australia increased from 17 (4.1%) to 198 (16.4%). Canadian and USA contributions increased respectively from 10 (2.4%) to 110 (9.1%) and 131 (32%) to 298 (24.7%). The top five journals that published RH articles were Journal of Rural Health (JRH; 453), Australian Journal of Rural Health (AJRH; 417), Medical Journal of Australia (MJA; 192), Social Science Medicine (191) and Lancet (171). The Australian journals with the largest number of RH publications were AJRH (374), MJA (177), Australian Family Physician (101), Rural Remote Health (55) and Journal of Telemedicine Telecare (54). The most frequent publication type was the journal article in all three countries. Australian publications comprised journal articles (85.1%), letters (9.1%), reviews (5.6%), editorials (4.7%) and clinical trials (2.9%). Australia had the lowest proportion of clinical trials of the three countries. Of the total 1290 Australian publications, 317 (25%) addressed the NHPAs. Of these, 118 (37.2%) addressed mental health, 54 (17%) cancer, 41 (12.9%) cardiovascular disease, 37(11.7%) injury prevention, 35(11%) diabetes and 15 (4.7%) arthritis and musculoskeletal conditions. DISCUSSION: Australia's contribution to the international RH literature is increasing, both in terms of the relative numerical contribution and the prominence of selected Australian journals as the destination for articles on RH topics. Of dedicated RH journals, AJRH is now almost as frequently used by authors as JRH. However the general journals Lancet, BMJ and MJA were also among the most frequent publishers of RH articles. Telemedicine and general practice journals (Australian Family Physician & Canadian Family Physician) were also among the top journals that published RH articles, which highlights the increasingly prominent role played by information and communication technologies in the delivery of rural health care in general practice settings. The most frequent NHPA addressed by the RH publications in Australia was mental health. However only approximately 1% of total Australian health publications from 1990 to 2005 addressed RH. There is still a pressing need for more RH research, particularly in health priority areas.

Health informatics research in Australia: retrospective analysis using PubMed.

OBJECTIVE: To obtain an overview of Australian health informatics (HI) research through a bibliometric analysis using PubMed. METHOD: Australian HI publications from 1970 to 2005 were downloaded in Medline format using PubMed queries. These were written to a Microsoft Access database using a software application, PubMed Grabber/Analyzer, developed by us. Search Query Language and online PubMed queries were used for further analysis. RESULTS: Publications increased from three (1970) to 335 (2005), with the rate increasing since 2002. Medical Journal of Australia (177), Australian Family Physician (66) and Australasian Physical and Engineering Sciences in Medicine (64) are the top three journals publishing HI articles. Coiera EW (21), Metcalfe P (19), Ebert MA (17), Kron T (16) and Westbrook JI (16) were the five most frequent authors. Of the 2350 total publications categorised according to PubMed publication types, there were 231 reviews, 137 clinical or randomised controlled trials, 64 letters, 44 editorials and 12 meta-analyses. From 1990 to 2005, Australian HI publications in PubMed increased 10-fold (34-335), compared with the total world HI publications, which increased from 2777 to 15 353. It also compared favourably with other medical discipline publications: general practice (69-346), cardiology (440-928) and public health (1779-5724). DISCUSSION: Australian HI publications in PubMed increased consistently throughout the period 1970-2005, which is on a par with world trends in HI publications. In Australia, most HI publications are in general medical journals. Lack of consistency in author names and failure to include the country name and even the state are the main obstacles to PubMed bibliometric analysis.

Increased expenditure on Australian health and medical research and changes in numbers of publications determined using PubMed.

OBJECTIVE: To determine temporal trends in PubMed publications for Australian authors compared with changes in funding for health and medical research (HMR). DESIGN: Retrospective observational study. SETTING: Internet-based bibliometric study that collated Australian HMR expenditure from the Australian Institute of Health and Welfare and Australian (and other) research publications from PubMed. MAIN OUTCOME MEASURES: Australian expenditure on HMR and numbers of PubMed-cited publications from 1980 to 2004, with subgroup analyses for universities, clinical trials, and genetic and biotechnology research, and comparison with similar results from the United Kingdom and New Zealand. RESULTS: From 1980-81 to 2003-04, Australian HMR expenditure increased from $66 million to $1503 million and total Australian PubMed publications increased from 844 to 13 836. From 1995-96 to 2003-04, Australian publications for university-derived research and for clinical trials increased at a fairly constant rate. Genetic and biotechnology publications increased about fivefold (49 to 277) between 1990-91 and 2003-04. Between 1990 and 2004, total publications increased from 1754 to 3288 for New Zealand and from 12 401 to 19 600 for the UK. CONCLUSIONS: There is an association between increased funding for HMR and increased publications, as determined using PubMed, in the past 10 years. Using PubMed may be a simple way to track output from HMR expenditure.

PubMed perspective of family medicine research: where does it stand?

OBJECTIVE: The aim of this study was to obtain a view of family medicine research by analyzing PubMed citations from 1960-2003. METHOD: Family practice (FP) citations in PubMed from 1960 to 2003 were downloaded in MEDLINE format. This was written into relation database using 'PubMed Grabber/Analyzer' software developed at University of Kelaniya, Sri Lanka. Search Query Language (SQL) and online PubMed queries were used for further analysis. RESULTS: There were 50288 FP citations from 80 countries. Of these, 33712 (67%) citations were from 15 FP journals. United Kingdom (18760), United States (13584), Australia (3262), Canada (1848), Germany-west (1340) were the five countries which had the most citations and 22 countries had less than 5 citations. Van Weel C (118), Geyman JP (116), Olesen F (87), Jones R (83) and Knottnerus JA (82) were numerically, the top five authors. Only 921 authors had more than 10 citations and the vast majority of authors had only one citation. Letters (5121), review (2715), editorial (2259), randomized controlled trials-RCT (1585) and Meta-analysis (44) were the top publication types. 40 citations found under 'qualitative research'. Discussion. The relatively few PubMed FP citations (50288) are by a small number of academics in developed countries. Citations showed an upsurge from the mid 1980s to the late 1990's but reached a plateau in the new millennium. Compared to PubMed citations from 1960-2003 in other specialties such as 2737655 for public health, 1151194 for cardiology & cardiovascular diseases and 318538 for medical informatics, the 50288 FP citations were paltry. Paucity of RCT (1585) and meta-analysis (44) was noted. The low 'qualitative research' citations (44) could have been due to the late introduction of the MeSH concept in 2003. CONCLUSIONS: Priority should be given to increase FP research and also to ensure the indexing of FP journals that are not currently indexed in PubMed. Efforts to increase citations in Medline may not give the desired results because of low priority given primary care specialties such as family medicine in the USA. Alternative solution of a separate bibliographic database for FP similar to PsycInfo may be too costly.

Three decades of the Ceylon Medical Journal--analysis using MEDLINE (PubMed).

INTRODUCTION: The Ceylon Medical Journal (CMJ) is the only Sri Lankan medical journal that is indexed in MEDLINE (PubMed). Publications in the CMJ from 1965 March to 2001 December were analysed using the PubMed interface of MEDLINE. METHOD: Using PubMed we downloaded the CMJ bibliography in MEDLINE format. Important tagged fields were written to a Microsoft-Access database using a PubMed Grabber/Analyser program. The analysis was done using Access-SQL and PubMed queries. RESULTS: There were 1472 citations by 1373 authors. 944 authors had only one and 176 had two articles. The top 10 authors contributed 8% and the top 25, 15.4% of the articles. Publications types were: 68.5% 'journal articles', 10.4% letters, 4.2% historical articles and 4.1% reviews. Controlled clinical trials, randomised controlled trials and clinical trials together totalled only 39 (2.1%). Articles were classified using 2 to 44 medical subject headings (MeSH; average 11.4, mode 9) from the MeSH vocabulary. CMJ articles classified using broad MeSH categories were (top five): infections 370(15 %), pathological conditions signs and symptoms 266( 10.8%), haemic, lymphatic and immunologic 199 (7.7%), endocrine, nutritional and metabolic 189 (7.7%), neoplasms 179(7.3%). DISCUSSION: For 938 (68%) authors, publishing in the CMJ was a one time affair. The top 50 authors contributed nearly a quarter (23.2%). A product of this research is an off-line CMJ searching system from 1965 to 2001 with menu driven search facilities which will be a useful tool for researchers.