Potential immediate hypersensitivity reactions following immunization in preschool aged children in Victoria, Australia.

Immediate hypersensitivity reactions (IHR) are rare but potentially serious adverse events following immunization (AEFI). Surveillance of Adverse Events following Vaccination in the Community (SAEFVIC) is an enhanced passive surveillance system that collects, analyses and reports information about AEFI in Victoria, Australia. We describe the incidence, timing and type of potential IHR following vaccination in preschool children reported over an 8-year period. A total of 2110 AEFI were reported in 1620 children, of which 23.5% (496) were classified as potential IHR. Of these, 37.1% (184) were suspected to be IgE-mediated, (including anaphylaxis, angioedema and/or urticaria) and 83.5% (414) occurred within 15 minutes of vaccination. The incidence of potential IHR was 5.4 per 100,000 doses, with that of suspected IgE-mediated IHR being 2.0 per 100,000 doses. The incidence of anaphylaxis was extremely low (0.13 per 100,000 doses) and is consistent with other published studies. Potential IHR following immunization should be reported to appropriate local pharmacovigilance systems and patients reviewed by specialists able to evaluate, investigate and manage future vaccinations.

Evaluation of an integrated curriculum using problem-based learning in a clinical environment: the Manchester experience.

DESCRIPTION OF COURSE: In 1994, a new problem-based leaning (PBL) curriculum for year 1 medical students was introduced at the University of Manchester. The use of PBL has continued into the clinical clerkships. Year 3 of the curriculum is based entirely in a clinical environment with PBL groups meeting in three teaching hospitals. During this year, all students undertake two integrated 14-week modules with overarching themes. Each week, groups of eight students discuss a trigger problem connected to the relevant theme. The steps the groups use in the PBL process have been amended to encourage students to link their discussion with clinical experience. EVALUATION: At the end of each module, all 309 students were requested to complete an evaluation questionnaire. The response rates were 80% (n=247) and 89% (n=275) for the two core modules. RESULTS: The students have remained 'happy with the way the course is going' (83% at the end of module 2). They were also asked to rate a number of statements on a 5-point Likert scale (5=strongly agree). Concerning PBL, the students remained confident about working in a group (median 4), producing a set of learning objectives (median 4) and linking clinical experience with other knowledge (median 4). However, there were changes over the year. Fewer students agreed at the end of module 2 that 'the working problems were stimulating' (P=0.002) or 'motivated them to learn' (P < 0.001), but the clinical firms were seen as providing more appropriate experience (P=0.01) and being aware of the new curriculum and responding to it (P=0.018). We also surveyed the PBL tutors and had 65 returns from 78 people involved in the 38 PBL groups in year 3. The great majority of these are doctors employed by the National Health service. Virtually all the responders were happy to continue being a tutor (97%) and would recommend it to a colleague (93%). CONCLUSIONS: The evaluation has been positive with PBL having been successfully implemented in a clinical environment. We have identified significant changes over the year, which we need to address as we consolidate the curriculum.

Does awarding a medical degree with honours act as a motivator or demotivator to student learning?

OBJECTIVES: To look at students' support for, and perception of, the effects of awarding a degree with honours. DESIGN: Questionnaires were given to all medical students from those entering year 1 to those graduating, i.e. six cohorts. We performed quantitative and qualitative analyses on the responses. SETTING: University of Manchester. SUBJECTS: Medical students. RESULTS: Of 1618 students, 1290 responded (80%). The majority of students thought that we should have a system to award a degree with honours (968/1290[75%]), but this support was related to a number of variables. When asked to rate their agreement to a series of statements, students from the later years were more likely to disagree that an honours system is a helpful motivator for students to learn (Kruskal-Wallis; P < 0.0001). In contrast, those students with 'points' counting towards an honours degree were more likely to agree that there should be an honours system (chi2[1]=18.7, P < 0.0001). CONCLUSIONS: Most students supported the honours system. However, there was less support from students in later years. The qualitative analysis showed a mixture of views. There was a relationship between the probability of being awarding a degree with honours and support of the system.

Agrobacterium radiobacter: a recently recognized opportunistic pathogen.

Over the past decade, an increasing number of infections due to Agrobacterium radiobacter have been reported. Observation of three cases of bacteremia due to this organism prompted a review of the English-language literature. Nineteen cases of significant disease have previously been reported. In more than one-half of the cases, bacteremia was the primary manifestation, often associated with the presence of an intravascular catheter. Other clinical syndromes (peritonitis, urinary tract infection, and endocarditis) have been described. Infection is strongly related to the presence of plastic foreign material, and effective treatment often requires removal of the device. Because antimicrobial sensitivity is variable, treatment must be based on sensitivity data for the individual isolate.