Comparison of public health specialty training in Australia and England.

OBJECTIVES: The objective of the study is to explore common challenges and distinct features of specialty public health training in Australia and England, given similarities in public health issues faced, shared histories and common political structures. STUDY DESIGN: The study design used in the study is a document review. METHODS: Using current curricula, along with other publicly available documents, we reviewed organisational, selection and content elements of public health specialty training in these two countries. RESULTS: In both countries, specialist public health training is coordinated and accredited through Faculties of Public Health housed within Royal Colleges of Physicians. However, eligibility, recruitment to training and funding routes differ. In England, entrants are accepted from a range of backgrounds including medicine, whereas only medical doctors are eligible in Australia. England has a national, annual recruitment process; Australia does not and has a less structured training path. In Australia, specialty advanced training is three years (excluding a Master's in Public Health [MPH]), whereas in England, training is generally five years (including an MPH). Curricula cover broadly common domains of public health practice although there are differences. Methods to assess readiness for consultant practice differ. CONCLUSIONS: Fostering an understanding of the specialist role of public health professionals in different countries establishes routes to share learning, encourage greater collaboration and creates opportunities for benchmarking.

Electrocardiographic measurement of infarct size after thrombolytic therapy.

OBJECTIVES: We examined the utility of the 32-point QRS score from the 12-lead electrocardiogram (ECG) for measurement of the ischemic risk region and infarct size in patients receiving thrombolytic therapy. BACKGROUND: The QRS score offers a means of evaluating the therapeutic benefit of thrombolytic therapy by comparing final infarct size with the initial extent of ischemic myocardium. METHODS: The study included 38 patients (34 men, 4 women; mean [+/-SD] age 54 +/- 10 years) with a first infarction (18 anterior, 20 inferior). The maximal potential QRS score (QRS0) was assigned to all leads with >/= 100-microV ST elevation on the initial ECG. The QRS scores were calculated at 7 and 30 days after infarction. Left ventricular ejection fraction was measured by radionuclide ventriculography at 1 month. Twenty-eight patients had thallium (Tl)-201 and technetium (Tc)-99m pyrophosphate tomographic measurement of the ischemic region and infarct size. RESULTS: The QRS0 was 10.3 +/- 3.1 (mean +/- SD) for anterior and 10.4 +/- 3.5 for inferior infarcts. The QRS scores were similar at 7 and 30 days for both anterior (5.6 +/- 3.4 vs. 5.5 +/- 3.4) and inferior infarcts (3.7 +/- 2.6 vs. 2.9 +/- 2.2). The day 7 QRS score and ejection fraction at 1 month were inversely correlated (r = -0.74, p < 0.01). The Tl-201 perfusion defect was 34 +/- 11% of the left ventricle for anterior and 32 +/- 7% for inferior infarcts. Subsequent Tc-99m pyrophosphate infarct size was 15 +/- 9% of the left ventricle for anterior and 17 +/- 9% for inferior infarcts. The QRS0 was correlated with the extent of the Tl-201 perfusion defect (r = 0.79, p < 0.001), and the day 7 QRS score was correlated with Tc-99m pyrophosphate infarct size (r = 0.79, p < 0.005). CONCLUSIONS: The 32-point QRS score can provide useful immediate measurements of the ischemic risk region and subsequent infarct size.

Treatment of surgical infections with tobramcin.

A survey of the safety and effectiveness of tobramycin, a newly developed aminoglycoside antibiotic, was assessed in 116 septic surgical patients. For comparison, the final 52 cases were randomized with 51 similarly infected patients who were treated with gentamicin. The two antibiotics gave equally good results when evaluated bacteriologically and clinically. Nevertheless, gram-negative infections appeared more likely to be susceptible to tobramycin than to gentamicin. No toxicity to the liver or bone marrow was observed. Although there were 13 cases of nephrotoxicity and 4 of ototoxicity, only one instance of such an adverse drug reaction could be attributed to parenterally administered aminoglycoside alone. In fact, topical neomycin and established renal damage caused by prior episodes of shock or dehydration appeared to be significantly more responsible for such adverse effects.

Alternative method for determination of contaminated heparin using chiral recognition.

Since 2008 a significant amount of work has focused on the development of methods to analyze contaminated heparin. This work focuses on utilizing heparin's ability to serve as a chiral selector as a means for determining contamination. Specifically, the effect of contamination on the separation of pheniramine and chloroquine enantiomers was explored. Separations were conducted using heparin contaminated with chondroitin sulfate at varying levels. For each pair of enantiomers, electrophoretic mobility and resolution were calculated. For pheniramine enantiomers, an increase in contamination leads to a decrease in the electrophoretic mobility and resolution. A linear relationship between contamination level and electrophoretic mobility of the pheniramine enantiomers was observed for the entire contamination range. A linear relationship was also found between contamination level and resolution of the enantiomers between 0 and 70 percent contamination. For the separation of chloroquine enantiomers, it was found that at low levels of contamination, the resolution of enantiomers was increased due to the secondary interaction between the chloroquine enantiomers and the chondroitin sulfate. Results of this study illustrate the potential of using chiral recognition as a means to determine heparin contamination as well as the improvement of the chiral resolution of chloroquine with the additional of low levels of chondroitin sulfate A.

Endemic gentamicin resistance R factors on a spinal cord injury unit.

Cleared lysates of gentamicin-resistant, gram-negative bacilli obtained during a prevalence survey and a subsequent prospective study on a spinal cord injury unit were analyzed. Of 105 strains obtained during the epidemiological study, 62 were analyzed for plasmid content. None of the 14 Acinetobacter strains carried plasmids. Of 20 strains from the initial prevalence survey, 9 carried a 36- or (in two cases) a 27-megadalton plasmid. Eight of the nine were Providencia strains; none were Pseudomonas strains. Of 28 nosocomial isolates obtained during the prospective survey, 22 carried plasmids of similar molecular weight (P less than 0.025, compared with the prevalence survey), including 20 of 22 isolates of members of the family Enterobacteriaceae and 2 of 6 Pseudomonas aeruginosa isolates. Conjugation, curing, and transformation indicate that these plasmids carry gentamicin, tobramycin, kanamycin, ampicillin, carbenicillin, cephalothin, and, variably, chloramphenicol resistance. Restriction endonuclease digestion of purified plasmid DNA suggests that the plasmids from multiple species of the family Enterobacteriaceae contain common sequences, whereas those from Pseudomonas spp. do not. This study suggests that an endemic conjugal 36-megadalton gentamicin resistance R factor exists in many nosocomial species of the family Enterobacteriaceae.

Variability in DNA sequence of closely related nosocomial gentamicin-resistant plasmids.

Endemic gentamicin-resistant plasmids derived from 12 species of gram-negative bacilli were analyzed by restriction-endonuclease digestion. These digests showed wide variations in digest patterns, but one or more common fragments were seen in all plasmids studied. Southern blot analysis using one plasmid as a probe revealed that most but not all of these plasmids shared extensive regions of homology. The variance observed in restriction-digest patterns could be accounted for either by introduction of unrelated DNA or by intramolecular events. We conclude that variation in restriction-digest patterns of endemic gentamicin-resistant plasmids is insufficient to establish that the plasmids are not closely related. Variation in molecular structure of closely related, endemic gentamicin-resistant plasmids may be more common than has previously been suspected.

Epidemiology of gentamicin-resistant, gram-negative bacillary colonization in a spinal cord injury unit.

A prospective epidemiological survey of a spinal cord injury unit for gentamicin-resistant, gram-negative bacilli was undertaken. The initial survey of the unit suggested a low level of cross-infection involving Pseudomonas aeruginosa and Providencia stuartii. However, a longitudinal study of new admissions revealed that only 13 of 52 nosocomial acquisitions could be considered to be due to cross colonization. Comparison of data on antibiotic use did not suggest selective pressure for resistant endogenous flora. Nosocomial acquisition was directly related to the length of the hospital stay. Antibiotic susceptibility testing of gentamicin-resistant, gram-negative bacilli showed only minor differences between nosocomial isolates and those present during the initial survey. Of the usual antimicrobial agents, amikacin, carbenicillin, and cefoxitin were the most active against all organisms, with the exception of Serratia spp. Of the new beta-lactams, ceftazidime and imipemide (N-formimidoyl thienamycin) were most active.