Adherence to antithrombotic therapy guidelines and atrial fibrillation in a rural hospital: a clinical audit.

INTRODUCTION: Atrial fibrillation (AF) is a major risk factor for ischaemic stroke and a common presentation in general practice. Scoring systems to guide antithrombotic treatment have been available since 1996, with the CHA2DS2-VASC in current use; however, little is known about adherence to guidelines in rural general practice. The purpose of this study was to determine whether patients in a rural population and with documented history of AF are prescribed antithrombotic treatment according to recognised guidelines. METHODS: A retrospective cohort study of inpatients was performed at a rural country hospital in South Australia. All patients with an ICD-10 CM code at the time of discharge were selected from June 2008 to July 2013. This included both newly diagnosed AF as well cases with existing history of AF. RESULTS: Among the 59 patients studied, 77% of patients received appropriate anticoagulation according to CHADS2 score and 83% according to CHA2DS2-VASC score. CONCLUSIONS: This study confirms that the guidelines are routinely followed in clinical practice in this rural population.

Am I getting an accurate picture: a tool to assess clinical handover in remote settings?

BACKGROUND: Good clinical handover is critical to safe medical care. Little research has investigated handover in rural settings. In a remote setting where nurses and medical students give telephone handover to an aeromedical retrieval service, we developed a tool by which the receiving clinician might assess the handover; and investigated factors impacting on the reliability and validity of that assessment. METHODS: Researchers consulted with clinicians to develop an assessment tool, based on the ISBAR handover framework, combining validity evidence and the existing literature. The tool was applied 'live' by receiving clinicians and from recorded handovers by academic assessors. The tool's performance was analysed using generalisability theory. Receiving clinicians and assessors provided feedback. RESULTS: Reliability for assessing a call was good (G = 0.73 with 4 assessments). The scale had a single factor structure with good internal consistency (Cronbach's alpha = 0.8). The group mean for the global score for nurses and students was 2.30 (SD 0.85) out of a maximum 3.0, with no difference between these sub-groups. CONCLUSIONS: We have developed and evaluated a tool to assess high-stakes handover in a remote setting. It showed good reliability and was easy for working clinicians to use. Further investigation and use is warranted beyond this setting.

Determining the Number of Ischemic Strokes Potentially Eligible for Endovascular Thrombectomy: A Population-Based Study.

BACKGROUND AND PURPOSE: Endovascular thrombectomy (ET) is standard-of-care for ischemic stroke patients with large vessel occlusion, but estimates of potentially eligible patients from population-based studies have not been published. Such data are urgently needed to rationally plan hyperacute services. Retrospective analysis determined the incidence of ET-eligible ischemic strokes in a comprehensive population-based stroke study (Adelaide, Australia 2009-2010). METHODS: Stroke patients were stratified via a prespecified eligibility algorithm derived from recent ET trials comprising stroke subtype, pathogenesis, severity, premorbid modified Rankin Score, presentation delay, large vessel occlusion, and target mismatch penumbra. Recognizing centers may interpret recent ET trials either loosely or rigidly; 2 eligibility algorithms were applied: restrictive (key criteria modified Rankin Scale score 0-1, presentation delay <3.5 hours, and target mismatch penumbra) and permissive (modified Rankin Scale score 0-3 and presentation delay <5 hours). RESULTS: In a population of 148 027 people, 318 strokes occurred in the 1-year study period (crude attack rate 215 [192-240] per 100 000 person-years). The number of ischemic strokes eligible by restrictive criteria was 17/258 (7%; 95% confidence intervals 4%-10%) and by permissive criteria, an additional 16 were identified, total 33/258 (13%; 95% confidence intervals 9%-18%). Two of 17 patients (and 6/33 permissive patients) had thrombolysis contraindications. Using the restrictive algorithm, there were 11 (95% confidence intervals 4-18) potential ET cases per 100 000 person-years or 22 (95% confidence intervals 13-31) using the permissive algorithm. CONCLUSIONS: In this cohort, ≈7% of ischemic strokes were potentially eligible for ET (13% with permissive criteria). In similar populations, the permissive criteria predict that ≤22 strokes per 100 000 person-years may be eligible for ET.

Translating a health service intervention into a rural setting: lessons learned.

BACKGROUND: Limited research exists on the process of applying knowledge translation (KT) methodology to a rural-based population health intervention. METHODS: This study reports on the implementation and translational stages of a previously described Co-creating KT (Co-KT) framework in the rural town of Port Lincoln, South Australia (population: 14,000). The Co-KT framework involves five steps: (i) collecting local data; (ii) building stakeholder relationships; (iii) designing an evidence-based intervention incorporating local knowledge; (iv) implementation and evaluation of the intervention; and (v) translating the research into policy and practice. Barriers and enablers to the overall Co-KT implementation process were identified. Our intervention focused on musculoskeletal (MSK) conditions. RESULTS: Although the Co-KT framework was valuable in engaging with the community, translating the final intervention into daily clinical practice was prevented by a lack of an accessible policy or financial framework to anchor the appropriate intervention, a lack of continued engagement with stakeholders, access problems to general practitioners (GPs) and Allied Health Professionals; and the paucity of referrals from GPs to Allied Health Professionals. Consequently, while many aspects of the intervention were successful, including the improvement of both function and pain in study participants, the full implementation of the Co-KT framework was not possible. DISCUSSION: This study implemented and evaluated a Co-KT framework for a population with MSK conditions, linking locally generated health care system knowledge with academic input. Further policy, health system changes, and on-the-ground support are needed to overcome the identified implementation challenges in order to create sustainable and effective system change.

Early career location of University of Adelaide rural cohort medical students.

INTRODUCTION: In 2001 the Australian Government Department of Health began what is now the Rural Clinical Training and Support (RCTS) program which funds rural background selection and rural clinical education in an attempt to increase the rural medical workforce. At the University of Adelaide, students of the 6-year undergraduate medical program have the opportunity to complete the whole of their fifth year of clinical studies at one of eight rural locations. This study seeks to track the early career movements of these graduates in order to determine the program's rural medical workforce impact. METHODS: The retrospective study involved graduates who had studied a rural fifth year between 2003 and 2010 inclusive. Only domestic students were included in the study. One hundred and twenty four out of a possible 127 participants were contacted by email and asked to complete a 28-question online survey using SurveyMonkey. The survey included questions regarding career choices since graduation and experiences during the RCTS program. Quantitative data was analysed using descriptive statistics and qualitative data underwent thematic analysis. RESULTS: The survey response rate was 58.2% with 74 useable responses. Respondents described the career choices they had made since graduation, including the stage they were at in their training, the speciality they had chosen and their location during each year. Data showed that between 2009 and 2012 between 20.8% and 34.1% of respondents were located in a rural area (Australian Standard Geographical Classification - Remoteness Areas 2-5). More than half of respondents have spent time in a rural area since graduation and 85.1% of respondents indicated they had intentions to work in a rural area in the future. In saying this, 8 years post-graduation is not long enough to assess the rural work force outcome. Graduates move frequently between practice locations even at 8 years post-graduation; only five respondents had completed postgraduate training. The RCTS program is important in the progression from medical school to rural practice, including the initial decision to take part in it. The interest of some respondents who were practising in rural areas in 2012, and were initially 'very interested' in rural practice, either 'slightly' or 'significantly increased'. CONCLUSIONS: These results show that the RCTS program can supplement an initial interest in rural medicine.

Adelaide stroke incidence study: declining stroke rates but many preventable cardioembolic strokes.

BACKGROUND AND PURPOSE: Stroke incidence rates are in flux worldwide because of evolving risk factor prevalence, risk factor control, and population aging. Adelaide Stroke Incidence Study was performed to determine the incidence of strokes and stroke subtypes in a relatively elderly population of 148 000 people in the Western suburbs of Adelaide. METHODS: All suspected strokes were identified and assessed in a 12-month period from 2009 to 2010. Standard definitions for stroke and stroke fatality were used. Ischemic stroke pathogenesis was classified by the Trial of ORG 10172 in Acute Stroke Treatment criteria. RESULTS: There were 318 stroke events recorded in 301 individuals; 238 (75%) were first-in-lifetime events. Crude incidence rates for first-ever strokes were 161 per 100 000 per year overall (95% confidence interval [CI], 141-183), 176 for men (95% CI, 147-201), and 146 for women (95% CI, 120-176). Adjusted to the world population rates were 76 overall (95% CI, 59-94), 91 for men (95% CI, 73-112), and 61 for women (95% CI, 47-78). The 28-day case fatality rate for first-ever stroke was 19% (95% CI, 14-24); the majority were ischemic (84% [95% CI, 78-88]). Intracerebral hemorrhage comprised 11% (8-16), subarachnoid hemorrhage 3% (1-6), and 3% (1-6) were undetermined. Of the 258 ischemic strokes, 42% (95% CI, 36-49) were of cardioembolic pathogenesis. Atrial fibrillation accounted for 36% of all ischemic strokes, of which 85% were inadequately anticoagulated. CONCLUSIONS: Stroke incidence in Adelaide has not increased compared with previous Australian studies, despite the aging population. Cardioembolic strokes are becoming a higher proportion of all ischemic strokes.

Aboriginal Families Study: a population-based study keeping community and policy goals in mind right from the start.

BACKGROUND: Australian Aboriginal and Torres Strait Islander women are between two to five times more likely to die in childbirth than non-Aboriginal women, and two to three times more likely to have a low birthweight infant. Babies with a low birthweight are more likely to have chronic health problems in adult life. Currently, there is limited research evidence regarding effective interventions to inform new initiatives to strengthen antenatal care for Aboriginal families. METHOD/DESIGN: The Aboriginal Families Study is a cross sectional population-based study investigating the views and experiences of Aboriginal and non-Aboriginal women having an Aboriginal baby in the state of South Australia over a 2-year period. The primary aims are to compare the experiences and views of women attending standard models of antenatal care with those accessing care via Aboriginal Family Birthing Program services which include Aboriginal Maternal Infant Care (AMIC) Workers as members of the clinical team; to assess factors associated with early and continuing engagement with antenatal care; and to use the information to inform strengthening of services for Aboriginal families. Women living in urban, regional and remote areas of South Australia have been invited to take part in the study by completing a structured interview or, if preferred, a self-administered questionnaire, when their baby is between 4-12 months old. DISCUSSION: Having a baby is an important life event in all families and in all cultures. How supported women feel during pregnancy, how women and families are welcomed by services, how safe they feel coming in to hospitals to give birth, and what happens to families during a hospital stay and in the early months after the birth of a new baby are important social determinants of maternal, newborn and child health outcomes. The Aboriginal Families Study builds on consultation with Aboriginal communities across South Australia. The project has been implemented with guidance from an Aboriginal Advisory Group keeping community and policy goals in mind right from the start. The results of the study will provide a unique resource to inform quality improvement and strengthening of services for Aboriginal families.

Abdominal adiposity and obstructive airway disease: testing insulin resistance and sleep disordered breathing mechanisms.

BACKGROUND: This study examined associations of abdominal adiposity with lung function, asthma symptoms and current doctor-diagnosed asthma and mediation by insulin resistance (IR) and sleep disordered breathing (SDB). METHODS: A random sample of 2500 households was drawn from the community of Whyalla, South Australia (The Whyalla Intergenerational Study of Health, WISH February 2008 - July 2009). Seven-hundred twenty-two randomly selected adults (≥18 years) completed clinical protocols (32.2% response rate). Lung function was measured by spirometry. Post-bronchodilator FEV1/FVC was used to measure airway obstruction and reversibility of FEV1 was calculated. Current asthma was defined by self-reported doctor-diagnosis and evidence of currently active asthma. Symptom scores for asthma (CASS) and SDB were calculated. Intra-abdominal fat (IAF) was estimated using dual-energy x-ray absorptiometry (DXA). IR was calculated from fasting glucose and insulin concentrations. RESULTS: The prevalence of current doctor-diagnosed asthma was 19.9% (95% CI 16.7 - 23.5%). The ratio of observed to expected cases given the age and sex distribution of the population was 2.4 (95%CI 2.1, 2.9). IAF was not associated with current doctor-diagnosed asthma, FEV1/FVC or FEV1 reversibility in men or women but was positively associated with CASS independent of IR and SDB in women. A 1% increase in IAF was associated with decreases of 12 mL and 20 mL in FEV1 and FVC respectively in men, and 4 mL and 7 mL respectively in women. SDB mediated 12% and 26% of these associations respectively in men but had minimal effects in women. CONCLUSIONS: In this population with an excess of doctor-diagnosed asthma, IAF was not a major factor in airway obstruction or doctor-diagnosed asthma, although women with higher IAF perceived more severe asthma symptoms which did not correlate with lower FEV1. Higher IAF was significantly associated with lower FEV1 and FVC and in men SDB mechanisms may contribute up to one quarter of this association.

The LINKIN Health Census process: design and implementation.

This paper describes the first phase of the LINKIN Health Study, which aims to evaluate health system functioning within a rural population. Locally relevant data on the health status and service usage of this population, including non-users and users, health service providers traditionally omitted from health services research, and multiple socio-economic indicators, was collected using a self-complete health census. Household response was 75% (N = 4425). Response was greater when face-to-face contact was made at delivery compared to when questionnaires were left in the letterbox (89% vs 64%), falling to 26% when no face-to-face contact was made at either delivery or collection.

Falls in old age: a threat to identity.

AIM AND OBJECTIVE: This study aimed to understand older people's perceptions of their and other older peoples' falls risk, to increase understanding of why older people might not believe falls are relevant to themselves. BACKGROUND: One-third of the people aged≥65 years (older people) fall yearly. Many older people do not participate in falls prevention programmes because they purport they are not personally vulnerable. DESIGN: A qualitative study was conducted, guided by the tenets of grounded theory. METHOD: Semi-structured interviews were conducted with nine community-dwelling older people living in metropolitan Adelaide, South Australia. The interview explored participant's direct and indirect experience of falling, their perceived chance of falling in the next 12 months and that of others of the same age and sex to themselves and their reasons for this. RESULTS: Participants carefully presented themselves as being 'not the type who fall', who they view negatively. They believed their or their friends past or future falls were (or could be) because of factors outside of their personal control or because they were not paying attention at that moment of falling, as opposed to being the type of person who falls. They used these explanations as strategies to maintain or protect their identity as being physically competent. CONCLUSIONS: Older people know that falling can be viewed negatively. Falling is a threat to their identity as the type of person who does not fall. This explanation is consistent with self-presentation theory, where people use accounting strategies in social interaction to create a desired impression. RELEVANCE TO CLINICAL PRACTICE: Falls prevention messages are likely to be rejected if the target group associate the message with a negative identity. These findings can assist nurses to understand older people's reluctance to engage in falls prevention and can stimulate thinking regarding alternative engagement strategies.

The South Australian Allied Health Workforce survey: helping to fill the evidence gap in primary health workforce planning.

There is a lack of detailed evidence about the allied health workforce to inform proposed health care reforms. The South Australian Allied Health Workforce (SAAHW) survey collected data about the demographic characteristics, employment, education and recruitment and retention of allied health professionals in South Australia. The SAAHW questionnaire was widely distributed and 1539 responses were received. The average age of the sample was 40 years; males were significantly older than females, the latter making up 82% of respondents. Three-quarters of the sample worked in the city; 60% worked full time and the remainder in part-time, casual or locum positions. 'Work-life balance' was the most common attraction to respondents' current jobs and 'Better career prospects' the most common reason for intending to leave. Practice in a rural location was influenced by rural background and rural experience during training. A greater proportion of Generation Y (1982-2000) respondents intended to leave within 2 years than Generation X (1961-81) or Baby Boomers (1943-60). Most respondents were satisfied with their job, although some reported lack of recognition of their knowledge and skills. Systematic, robust allied health workforce data are required for integrated and sustainable primary health care delivery.

Vitamin D insufficiency in Aboriginal Australians.

OBJECTIVE: To investigate the adequacy of vitamin D status in a South Australian Aboriginal population, and to examine the relationship between serum 25-hydroxyvitamin D (25-OHD) levels and biochemical variables of calcium and bone mineral homeostasis, as well as other factors which may influence vitamin D synthesis, storage and metabolism. DESIGN, SETTING AND PARTICIPANTS: A single-visit, observational study of 58 adults from two Aboriginal community-controlled health services in Adelaide and Yalata, South Australia. Participants were recruited between May 2008 and December 2009. MAIN OUTCOME MEASURES: Serum levels of 25-OHD, parathyroid hormone (PTH), fasting glucose and fasting C-terminal telopeptides of type I collagen (ß-CTx). RESULTS: Serum 25-OHD levels showed clear seasonal variation, being higher in summer (P < 0.001). The overall mean level was 56.8 nmol/L (SD, 22.1), which is below the recommended target level of 60 nmol/L. Serum 25-OHD levels correlated significantly with ß-CTx (P = 0.03), but not with age, body mass index (BMI), PTH levels or levels of fasting glucose. A significant association was found between BMI and PTH levels (P = 0.001). A significant inverse association between serum 25-OHD levels and BMI, observed in other studies, was not found in our study. CONCLUSIONS: Vitamin D insufficiency is highly prevalent in this population of adult Aboriginal Australians, with low mean values found in all seasons other than summer.

Older persons and heat-susceptibility: the role of health promotion in a changing climate.

ISSUE ADDRESSED: Many studies world wide have provided evidence that older persons are a sub-population at increased risk of heat-related morbidity and mortality. This article gives an overview of the current state of knowledge of risk factors and provides commentary on the role of health promotion in the prevention of a climate change-related increase in elderly heat casualties. METHODS: A search of peer-reviewed medical and epidemiological literature and community health websites was conducted in order to gain an in-depth understanding of heat-susceptibility in the elderly and preventive strategies. Key search words included: elderly, aged, older, heat, thermoregulation, heat wave, mortality, heat effects, dehydration, heat-related illness, adaptation, adaptive capacity. RESULTS: The reasons underlying reduced heat tolerance in this group are multi-faceted, comprising physiological, social and behavioural limitations, with comorbidities and polypharmacy being contributing factors. Additionally, some older persons may be unable or reluctant to undertake adaptations necessary to maintain thermal homeostasis due to diminished awareness of the heat, lowered thirst sensation, mobility or cognitive impairments, a lowered perception of risk, or economic concerns. CONCLUSION: With older persons in poor health being particularly vulnerable to heat, preventive messages need to promote protective behaviours and help build resilience as temperatures rise.

Global health education for medical undergraduates.

CONTEXT: The Rural Undergraduate Support and Coordination (RUSC) program has stimulated teaching in remote indigenous health, primary health care and international health for Australian students prior to their placements. Medical students have traditionally taken electives in the developing world, although these electives are of variable use to the communities hosting them and to the students. Calls for development of a curriculum in international or global health have resulted in some attempts to define a curriculum. An International Health (IH) course at the University of Adelaide Medical School, South Australia, has evolved since 1999. ISSUES: The IH course has functioned both as an introduction to the social determinants of health and as a pre-departure course for student electives. The sequence progresses from general information to disease specific information and service provision for refugees and returning travellers. Experienced presenters deliver the content; student assessment is via a group development program proposal. LESSONS LEARNT: The current course aligns with international thinking on 3 structural themes for global health: the burden of global disease, travellers' medicine and immigrant/refugee health. Student opinion expressed in qualitative evaluation has been largely positive and consistent with the debate about whether this content should be a core unit or an elective part of the curriculum. From 2011 the course will be known as 'Global Health' and ongoing content development is expected.

Distress levels and self-reported treatment rates for medicine, law, psychology and mechanical engineering tertiary students: cross-sectional study.

OBJECTIVE: The aim of this research was to assess tertiary student distress levels with regards to (i) comparisons with normative population data, and (ii) the effects of discipline, year level, and student characteristics. Self-reported treatment rates and level of concern regarding perceived distress were also collected. METHOD: Students from all six years of an undergraduate medical course were compared with samples from Psychology, Law and Mechanical Engineering courses at the University of Adelaide, Australia. Students participated in one of three studies that were either web-based or paper-based. All studies included Kessler's Measure of Psychological Distress (K10), and questions pertaining to treatment for any mental health problems and concern regarding distress experienced. RESULTS: Of the 955 tertiary students who completed the K10, 48% were psychologically distressed (a K10 score > or = 22) which equated to a rate 4.4 times that of age-matched peers. The non-health disciplines were significantly more distressed than the health disciplines. Distress levels were statistically equivalent across all six years of the medical degree. Of tertiary students, 11% had been treated for a mental health problem. Levels of concern correlated with the K10 score. CONCLUSION: The results from this research suggest that high distress levels among the tertiary student body may be a phenomenon more widely spread than first thought. Low treatment rates suggest that traditional models of support may be inadequate or not appropriate for tertiary cohorts.

Exploring the need to update lung age equations.

AIMS: A renewed interest in lung age is evidenced by recent smoking cessation publications. This research compares the original Morris lung age equations (1985) with contemporary Australian lung age equations. METHODS: Both lung age equations were applied to the spirometry results of two sub-groups (never-smokers n=340, and current smokers n=50) from an independent dataset. Means of both lung age estimates were compared to the mean of the chronological age of each group by paired Student's t-test. RESULTS: The Morris lung age estimates were paradoxically lower (younger) than chronological age in both groups. The new Australian equation produced lung age estimates that were equivalent to chronological age in the never-smoker group and significantly higher (older) than chronological age in the current smoker group. CONCLUSIONS: These results strongly suggest that the Morris lung age equations are in need of review. The use of contemporary lung age equations may translate into greater success for smoking cessation programs. The new Australian equations seem to possess internal validity.

Education to improve cancer care in rural South Australia.

INTRODUCTION: Cancer management follows the overall trend of rural health disparities, with higher incidence rates of preventable cancers and lower survival rates in rural Australia. Cancer prevention and management has been identified as a priority area and Cancer Australia has funded a variety of innovations throughout Australia. The Rural Chemotherapy Mentoring Program (RCMP) forms part of this drive to improve access to chemotherapy for rural based cancer sufferers in South Australia (SA). The key strategy of this program was the provision of opportunities for rural health clinicians (nurses and GPs) to enhance their knowledge and skills in the delivery of chemotherapy and cancer care through clinical placements at metropolitan oncology units. The RCMP enrolled 43 current SA rural clinicians (five GPs and 38 nurses). This evaluation was undertaken at the end of RCMP's initial 18 months. It considered how those involved in the RCMP perceived development and delivery of the RCMP, identifying key aspects of the program that were successful. This report emphasises lessons learnt which may be of relevance more widely in the development of other rural health professional education. METHODS: The evaluation used a mixed method approach, designed to accommodate different perspectives from the health professionals with different roles in the program. Quantitative and qualitative questionnaire data from clinician participants, their employers, and providers of education at metropolitan cancer units, were supplemented with qualitative interview data from these sample groups and from the program's steering committee. The analysis used interpretative methods to examine the key strengths, limitations and the potential for future development of the program. RESULTS: The vast majority of participants, employers, providers of training and the steering committee representatives expressed high levels of overall satisfaction about their involvement in RCMP. A clear identifiable need for increased knowledge and skills in cancer care was expressed by rural clinical participants pre-clinical placement. Technical aspects of the delivery of some chemotherapy protocols and the steps in safely preparing patients to receive chemotherapy were key areas where respondents lacked confidence prior to their clinical placement. Post-placement self-evaluation data highlighted improvements in participants' understandings and confidence about chemotherapy, and cancer care knowledge. Participants and their employers identified change in specific work activities resulting from their new knowledge. The program's limitations were identified. CONCLUSIONS: Knowledge acquisition was a key to the success of the program, and the transfer of experience between rural and urban based clinicians was an important aspect of this. Generalisable recommendations for further improvement of the RCMP include: (1) clearly define and articulate a precise learning objective of the program; (2) involve staff who will directly deliver mentoring in planning of the program; (3) allow time in the planning phase to resolve complex indemnity issues across workplaces; and (4) provide funding for a dedicated trainer (preferably a staff member within the unit) to supervise placements in busy urban oncology clinics.

Rural student entry into a medical course: a South Australian rural high school perspective.

INTRODUCTION: Rural background is an acknowledged predictor of later rural medical practice. This study aimed to explore why only small numbers of high school students from rural South Australia seek entry to the University of Adelaide Medical School. METHOD: Questionnaires were designed to explore the interest in, knowledge of and attitudes about studying medicine of rural high school students, their parents and their careers counsellors. A stratified sample of 15 high schools in rural South Australia was selected. Data were collected from all participants on perceptions and knowledge of the entry processes and subject requirements for studying medicine. Student participants were also asked about their interest in studying medicine and becoming a doctor. RESULTS: Four hundred and sixty-one rural year 11 and 12 students, 512 parents of rural year 11 and 12 students, and 12 rural high school careers advisors returned useable data. Students, parents and career advisors were found to hold inaccurate perceptions of the minimum Tertiary Entrance Rank, and they incorrectly believed prerequisite subjects were required in order to study medicine at the University of Adelaide. Analysis identified a group of students interested in a career as a doctor but who had never considered studying medicine. The majority of students who had seriously considered studying medicine reported a lack of knowledge of admission processes and the requirements for studying medicine. Among students who found becoming a doctor appealing, those who had never considered medicine had less confidence regarding and knowledge of requirements and entry processes into medical courses than those who had. CONCLUSION: Some keen rural students have inadequate or inaccurate information about medical courses and admissions processes, which will deter them from applying to study medicine. Another group of students were identified who were attracted to a medical career but had not sought information on entry to a university undergraduate medical course. Both groups might be encouraged to progress their application to a medical school through 'academic detailing visits' to rural high schools, targeting medical careers promotion and provision of accurate and timely information on applying for and studying medicine.

A pilot study to evaluate Australian predictive equations for the impulse oscillometry system.

BACKGROUND AND OBJECTIVE: Impulse oscillometry (IOS) measures respiratory function during normal breathing by transmitting mixed frequency rectangular pressure impulses down the airways and measuring the resultant pressure and flow relationships, which describe the mechanical parameters of the lungs. Respiratory impedance and its components, airways resistance and reactance, at a range of frequencies from 0.1 to 150 Hz are calculated by computer analysis. The IOS software generates predictive normal values for each of the parameters measured, including total airway resistance (R5), proximal airway resistance (R20) and peripheral capacitive reactance (X5). However, these values are based on German data and no other Caucasian data or Australian normative data exist. METHODS: This was a cross-sectional study of over 100 community dwelling adults, with about 10 men and 10 women per 10-year cohort. Inclusion criteria were age between 25 and 74 years and apparently good respiratory health. Exclusion criteria were smoking, asthma and acute or chronic respiratory disease. IOS and spirometry were performed on all participants. RESULTS: Australian predictive normal equations were generated and compared with current published equations. The IOS parameters were correlated with the spirometric data. Results were analysed by gender, age, height and weight, and compared with the predicted normal values for each parameter provided by the German manufacturer of the IOS instrument. CONCLUSIONS: A preliminary set of Australian predictive equations have been produced for the IOS. These have been compared with international equations. IOS has potential applications in a range of respiratory diseases and in population screening for occupational health assessment.