A Randomised Assessment of Trainee Doctors' Understanding and Interpretation of Diagnostic Test Results.

INTRODUCTION: Doctors are unfamiliar with diagnostic accuracy parameters despite routine clinical use of diagnostic tests to estimate disease probability. METHODS: Trainee doctors completed a questionnaire exploring their understanding of diagnostic accuracy parameters; ability to calculate post-test probability of a common surgical condition (appendicitis) and their perceptions on training in this area. To determine whether the method of information provision altered interpretation, trainees were randomised to receive diagnostic test information in three ways: positive test only; positive test with specificity and sensitivity; positive test with positive likelihood ratio in layman terms. RESULTS: 326 candidates were recruited across 30 training sessions. Trainees scored a median of three out of seven in questions concerning knowledge of diagnostic accuracy parameters. This was affected neither by training level (P = 0.737) nor by experience in acute general surgery (P = 0.738). 30 (11.8%) candidates correctly estimated post-test probability; with 86.6% overestimating this value. Neither level of training (P = 0.180) nor experience (P = 0.242) influenced the accuracy of the estimate. Provision of the ultrasound scan results in different ways was not associated with likelihood of a correct response (P = 0.857). CONCLUSION: This study highlights the deficiencies in trainee doctors' understanding and application of diagnostic tests results. Most trainees over-estimated disease probability, increasing the risk of unnecessary intervention and treatment.

Targeting the endoplasmic reticulum mediates radiation sensitivity in colorectal cancer.

BACKGROUND: Radiotherapy is an established treatment modality for early and locally advanced rectal cancer as part of short course radiotherapy and long course chemoradiotherapy. The unfolded protein response (UPR) is a cellular stress response pathway often activated in human solid tumours which has been implicated in resistance to both chemotherapy and radiotherapy. This research has investigated whether the UPR pathway is upregulated in ex-vivo samples of human colorectal cancer and characterised the interaction between radiotherapy and UPR activation in two human colorectal cancer cell lines in vitro. METHODS: In vitro UPR expression was determined in response to clinical doses of radiotherapy in both the human colorectal adenocarcinoma (HT-29) cell line and a radio-resistant clone (HT-29R) using western blotting and quantitative polymerase chain reaction. The UPR was induced using a glucose deprivation culture technique before irradiation and radiosensitivity assessed using a clonogenic assay. Ex-vivo human colorectal cancer tissue was immuno-histochemically analysed for expression of the UPR marker glucose regulated protein 78 (GRP-78). RESULTS: The UPR was strongly up regulated in ex-vivo human colorectal tumours with 36 of 50 (72.0%) specimens demonstrating moderate to strong staining for the classic UPR marker GRP-78. In vitro, therapeutic doses of radiotherapy did not induce UPR activation in either radiosensitive or radioresistant cell lines. UPR induction caused significant radiosensitisation of the radioresistant cell line (HT-29R SF2Gy=0.90 S.E.M. +/-0.08; HT-29RLG SF2Gy=0.69 S.E.M. +/-0.050). CONCLUSION: This suggests that UPR induction agents may be potentially useful response modifying agents in patients undergoing therapy for colorectal cancer.

Evaluation of a humidified nasal high-flow oxygen system, using oxygraphy, capnography and measurement of upper airway pressures.

In this study, we evaluated the performance of a humidified nasal high-flow system (Optiflow, Fisher and Paykel Healthcare) by measuring delivered FiO, and airway pressures. Oxygraphy, capnography and measurement of airway pressures were performed through a hypopharyngeal catheter in healthy volunteers receiving Optiflow humidified nasal high flow therapy at rest and with exercise. The study was conducted in a non-clinical experimental setting. Ten healthy volunteers completed the study after giving informed written consent. Participants received a delivered oxygen fraction of 0.60 with gas flow rates of 10, 20, 30, 40 and 50 l/minute in random order FiO2, F(E)O2, F(E)CO2 and airway pressures were measured. Calculation of FiO2 from F(E)O2 and F(E)CO2 was later performed. Calculated FiO2 approached 0.60 as gas flow rates increased above 30 l/minute during nose breathing at rest. High peak inspiratory flow rates with exercise were associated with increased air entrainment. Hypopharyngeal pressure increased with increasing delivered gas flow rate. At 50 l/minute the system delivered a mean airway pressure of up to 7.1 cm H20. We believe that the high gas flow rates delivered by this system enable an accurate inspired oxygen fraction to be delivered. The positive mean airway pressure created by the high flow increases the efficacy of this system and may serve as a bridge to formal positive pressure systems.

Eliciting views of Australian pharmaceutical industry employees on collaboration and the concept of Quality Use of Medicines.

BACKGROUND: Pharmaceutical industry involvement in biomedicine has produced major benefits but has also caused concern. At present, there is no consensus as to how medical and government organizations should relate to the pharmaceutical industry and this is partly due to the absence of systematic study of the various alternatives. In Australia industry cooperation has been elicited through the 'Quality Use of Medicines' (QUM) framework within the 'National Medicines Policy'. Little is known about the way employees of pharmaceutical companies respond to the QUM policy and strategies. AIMS: To examine the engagement of the Australian pharmaceutical industry with QUM with a view to assisting medical, government and consumer organizations who may wish to collaborate with industry. METHODS: We carried out a qualitative study using in-depth, semistructured interviews with industry employees, primarily from medical and regulatory affairs departments. RESULTS: Employees of pharmaceutical companies claim that collaboration is important, and that they are altruistic and committed to QUM. At the same time, there is little evidence from this study to support the notion that QUM has brought about structural changes to industry or is positioned as the central goal or framework in designing a company's operational strategies. Moreover, there is a significant degree of ambivalence towards governments and medical organizations. CONCLUSIONS: Employees within the pharmaceutical industry claim a commitment to collaboration and QUM. While these claims cannot be taken entirely at face value, there is potential for meaningful collaboration with industry.

Sex differences and similarities in job attribute preferences: a meta-analysis.

Many researchers have studied sex differences in job attribute preferences. The authors meta-analyzed 242 samples collected from 321,672 men and boys and 316,842 women and girls in the United States between 1970 and 1998. Findings indicated significant (p < .05) sex differences on 33 of 40 job attribute preferences examined. The effect sizes were small. Of the 33 significant differences, 26 had average effect sizes of magnitude .20 or less. The directions of the differences were generally consistent with gender roles and stereotypes. Many job attributes became relatively more important to women and girls in the 1980s and 1990s compared with the 1970s, indicating that women's aspirations to obtain job attributes rose as gender barriers to opportunity declined.

Spreading the word: Teaching health promotion to students from disciplines other than health.

Intersectoral collaboration has gained acceptance as a strategic approach in promoting health, based on the assumption that the main determinants of health are social, physical and politico-economic factors and not medical care utilization. However, the difficulties of collaborating intersectorally for better health have become apparent over the last two decades. This paper describes an attempt to address these difficulties through an awareness-raising educational initiative devised for undergraduate university students from disciplines other than health. The course aims to raise students' appreciation of the ways in which their future occupations could have an impact on the health of others through intersectoral collaboration and the creation of environments that are supportive of health. The evaluation of the course, which comprised a peer-review process, a questionnaire seeking student feedback, and a task exploring students' ideas on how they could influence the health of others, demonstrated that students recognized the value of working intersectorally for better health. If intersectoral collaboration is really expected to be the way forward that many public health theorists claim, then this small but effective contribution should best be seen as one of a series of incremental building blocks leading to the desired effects.

Reflections on prevention in dieting-induced disorders.

OBJECTIVE: The purpose of this article is to reflect on current approaches to the prevention of anorexia nervosa and bulimia nervosa. METHOD: The literature on preventing those disorders was examined within the context of the published literatures concerned with preventive interventions for adolescent drug-taking and alcohol-related behaviors. RESULTS: Our review revealed that those involved in preventing eating disorders maintain the traditional distinction between primary and secondary prevention, although the fruitfulness of that categorization is now uncertain. DISCUSSION: It is argued that interventions for dieting-induced disorders ought to be generic, and target the gamut of transitional risk behaviors among adolescents. Programs for dieting, cigarette smoking, alcohol use, and safe sex within the health and social development curricula in schools must be sustained by comprehensive efforts within the broader context of societal and systemic change.

Education for primary health care: accommodating the new realities.

The didactic, authoritarian model in which learners are lectured by teachers cannot meet the needs of people intending to work in health systems where equity, self-reliance, community participation and intersectoral collaboration are the watchwords. The author discusses how the education of health professionals for roles in primary health care should be conducted.

PIP: The global community has been encouraged to adopt primary health care (PHC) as the means of achieving a prevention focus. Degree of activity had been used to assess a health service's effectiveness, while now, with PHC, it is incidence and/or prevalence of various conditions. The shift has changed budgetary allocations and procedures. Health professional training has not kept up with the changes, however. In the Western model, the skill and knowledge of health professionals, which result in the cure or alleviation of patients' conditions and their patients' appreciation, are a source of personal satisfaction. This type of reward is reduced in the PHC system, because the link between health professionals' efforts and the health of the people is less apparent. Few training institutions rate students' performance on their ability to identify preventive actions or determinants of disease. Usual clinical care fosters specialization and hierarchical relationships between disciplines. It is hard to convince people to choose disease prevention and health promotion when determinants of incidence are not always the same as the causes of individual cases. Clinical health workers are unaware of patients' lifestyles and living conditions. The World Health Organization [WHO] Regional Training Centre for Health Development at the University of New South Wales in Australia has made recommendations to bring about changes in health professional training. Health professionals should be integrated into the systems in which they operate. Policymaking bodies, training institutions, and professional associations should coordinate planned, interdependent change in human resources, management systems, and policies. Instructors should stress community participation, intersectoral collaboration, self-reliance, and equity. Students should develop plans to change learning into action and to implement them, if appropriate. Training institutions should start with the familiar and move to the new. Role modelling can be effective at bringing about needed changes in rewards.

Fabrication of conducting polymer interconnects.

A nonmechanical approach to the construction of complex three-dimensional interconnect arrays has been developed with the use of conducting polymer dendrites. Electrically independent connections between pairs of wires in an array were successfully grown through alternating-current electrochemical polymerization of poly(3-methylthiophene), without mechanical or optical masking steps. The electrically active links were insulated by subsequent electropolymerization of 4-vinylpyridine or 2-methylthiophene or by the dip-coating of the connections in a polystyrene solution.

Keeping australians healthy: the challenge to physiotherapy practice posed by the concept of the new public health.

This Keynote Address considers issues around 'The Healthy Australian', the theme of the 1988 APA National Conference. The concept of the New Public Health requires physiotherapists to review the role they traditionally have held in health care delivery, and to address some key issues in order to meet the needs of their patients and clients more effectively. These issues include developing the most appropriate client/professional relationship, and considering the main elements in education for health and in supporting clients achieve effective coping skills. This paper also addresses some practicalities in legitimizing physiotherapists' involvement in disease prevention and health promotion, and in working with clients in ways that allow a balance of responsibility to be shared appropriately by both parties.