Side-effects associated with ketamine use in depression: a systematic review.

This is the first systematic review of the safety of ketamine in the treatment of depression after single and repeated doses. We searched MEDLINE, PubMed, PsycINFO, and Cochrane Databases and identified 288 articles, 60 of which met the inclusion criteria. After acute dosing, psychiatric, psychotomimetic, cardiovascular, neurological, and other side-effects were more frequently reported after ketamine treatment than after placebo in patients with depresssion. Our findings suggest a selective reporting bias with limited assessment of long-term use and safety and after repeated dosing, despite these being reported in other patient groups exposed to ketamine (eg, those with chronic pain) and in recreational users. We recommend large-scale clinical trials that include multiple doses of ketamine and long-term follow up to assess the safety of long-term regular use.

Influence of rural background and rural medical training on postgraduate medical training and location in New Zealand.

AIMS: To evaluate the influence of the Otago Medical Programme's rural entry pathway and rural immersion programme on postgraduate medical training and location. METHODS: Retrospective cohort study of 2008-2011 medical school graduates. Rural background/training included students gaining preferential entry to medical training based on rural residence or schooling, and/or those who spent a year training in a rural setting. Postgraduate medical training and location were obtained from the NZ Medical Register in December 2013. RESULTS: 112/733 students (15.3%) had rural background/training. Significantly more students with rural background/training were training in rural hospital medicine or general practice after graduation. Multiple logistic regression identified both variables (rural background and rural training) as independently statistically significant (Odds Ratios (95%CI); rural background OR 2.1, 95%CI 1.2-3.6; rural training OR 2.5, 95%CI 1.4-4.5; p=0.002). Almost twice as many students with rural background/training were working in non-Major Urban Centres. CONCLUSIONS: These findings are similar to international reports on the influence of medical schools' rural initiatives on postgraduate training choices and practice location. University policies aimed at increasing the proportion of medical graduates practising in rural areas appear to be working as intended.

Postgraduation retention of medical students from Otago and Auckland medical programmes.

AIM: Auckland and Otago medical programmes have different methods for selecting students. This study compared postgraduate retention in New Zealand (NZ) of medical graduates from the two medical programmes, to assess whether different selection methods influenced retention. Other variables assessed included entrance category and age at graduation. METHODS: Anonymised databases were created of all graduates from the Otago Faculty of Medicine (1999-2011) and the Auckland medical programme (2000-2012). Demographic and entry category data were recorded. Retention was defined as presence on the NZ Medical Register in December 2012. Risk differences (RD) were calculated to compare retention between the two medical programmes using the Mantel-Haenszel method. The influence of medical programme entrance category on retention was also tested. The influence of covariates on retaining graduates on the register was evaluated using a multiple logistic regression model. RESULTS: The postgraduate retention of graduates of the two medical programmes over 13 years was identical (Auckland 74.9%, Otago 73.6%, P=0.48). Retention of graduate and non-graduate entry students from both medical programmes was similar by 6 years after graduation. Age during medical school did not affect retention. DISCUSSION: University of attendance had no effect on postgraduation retention of students on the NZ Medical Register, suggesting that retention is not influenced by the different student selection methods at each programme. The data presented shows that New Zealand graduates regardless of programme completed show a similar profile in terms of retention.

Factors related to postgraduate retention of medical graduates in New Zealand.

AIMS: To examine the influence of a number of variables, including age and medical school entrance category, on postgraduate retention of New Zealand (NZ) medical graduates. METHODS: An anonymised database was created of all graduates from the Otago School of Medicine (1999-2010), with demographic and entry category data. The NZ Medical Register was checked in January 2012 to identify which graduates remained in NZ. Risk Differences (RD) were calculated to compare retention between medical school entrance categories by year of graduation using the random effects Mantel-Haenszel method. The influence of covariates on remaining on the New Zealand Medical Register was evaluated using logistic regression. RESULTS: The odds of remaining on the NZ Medical Register increased by 7% for each additional year of age at graduation (Odds Ratio=1.070, 95%CI 1.038-1.113, p<0.001). Compared with students who entered medical school after a competitive first year exam, retention of students who entered after completion of a bachelor's degree was 7% higher, and 20% higher for "Other Category" (older, work experienced) students. Multiple logistic regression identified medical school entry category as the only significant predictor of higher retention. CONCLUSIONS: Admission policies favouring graduate entry and "Other Category" students could contribute to increased retention of NZ medical graduates.

Academic performance and career choices of older medical students at the University of Otago.

AIMS: To compare the academic performance and postgraduate career choices of a cohort of medical students who are older and more life experienced at time of medical school entry ("Other Category" students) with students admitted through standard entry admission pathways. METHODS: Examination performance, graduation rates, postgraduate specialisation and geographical location were compared between Other Category students and students entering via Standard Entry admission (including competitive first year entry and competitive graduate entry immediately after completing a Bachelor's degree). RESULTS: Compared with Standard Entry students, Other Category students had equivalent examination pass rates, significantly higher rates of distinction passes in examinations in Year 2 (OR 1.86; 95% CI 1.05, 3.29; p=0.03) and Year 5 (OR 2.36; 95% CI 1.27, 4.37; p=0.005), and equivalent graduation rates. Retention of Other Category graduates in New Zealand was 14% higher than Standard Entry students over 10 years post-graduation (p<0.0001), and a higher proportion had specialised in General Practice (p=0.04). CONCLUSIONS: Compared with Standard Entry students, Other Category medical students had higher rates of distinction grades in examination results, higher rates of retention in NZ post-graduation, and a higher proportion taking up general practice as a specialty. These findings may be relevant in planning for recruitment and training of the future medical workforce in New Zealand.