Hydration Strategies for Physical Activity and Endurance Events at High (>2500 m) Altitude: A Practical Management Article.

ABSTRACT: A growing number of adventurous athletes are seeking new challenges through endurance events or physical activities held at high altitude (>2500 m). This coincides with a significant increase in the numbers of trekkers who ascend into the world's mountains. Altitude itself influences and complicates the athlete's effective and safe hydration. This article considers the physiology of adaptation to altitude and the effects on hydration at altitude compared with sea level, reviews the "ad libitum versus programmed hydration" controversy in conventional endurance event hydration, examines the evidence for extrapolation of sea level hydration strategies to the high-altitude environment, and synthesizes these disparate factors into a set of practical recommendations for hydration management during high-altitude physical activity. The guidelines will be relevant to participants of physical activity at altitude and health care staff who may care for them in the preparation or performance phases of their adventure.

What Is an Extreme Sports Healthcare Provider: An Auto-Ethnographic Study of the Development of an Extreme Sports Medicine Training Program.

"I remember when sex was safe and skydiving was dangerous" read a popular bumper sticker during the HIV crisis. Popular perceptions of extreme sport (ES) often include the descriptor 'dangerous'. Therefore, why is the popularity of ES increasing exponentially with "dedicated TV channels, internet sites, high-rating competitions, and high-profile sponsors drawing more participants"? More importantly, how should health practitioners respond to the influx of ES athletes with novel injuries, enquiries and attitudes. This paper describes the results of a collaborative auto-ethnographic approach to answering "what is an extreme sports medicine health care provider and what are the components of an effective Extreme Sports Medicine (ESM) training program?" The study was conducted following the first ESM university course offered in Australia with the intention of assessing the learning design and reflecting on the development and practice of ES health practitioners. We explicated three overarching themes common to both the ES health practitioner and for the effective training of healthcare providers in the support of ES endeavors and athletes. These themes were individual, task and environmental factors. The impacts of these findings confirm that ESM courses are vital and should be designed specifically to ensure that practitioners are effectively supported to develop the unique skills necessary for practice in real world extreme sports events.

Teaching on the run--general practice training between consultations.

BACKGROUND: General practitioner teachers play a growing role in medical education. Much of the teaching is done during and between patient consultations, ie. 'on the run'. This presents challenges in terms of time available for teaching, teacher training and feedback on teacher performance. Australian Government funded programs have been developed to train clinical teachers in hospital settings; these might be adaptable to the general practice setting. OBJECTIVE: This article describes a project aimed to adapt current programs to the needs of GP teachers, and present them in workshops around Tasmania. DISCUSSION: The adapted program was well received by workshop participants, who reported significant increase in knowledge and skill in teaching, and a change in attitude to teaching in their practices. The program will be continued and expanded to encourage more GPs, general practice registrars and senior medical students to teach on the run.

A new perspective on "development" skills and their place within research training programmes in primary care.

The gap between research and policy and practice is well documented. So too is the relative paucity of research undertaken in general practice. Various programmes have been initiated to address these issues in different countries. As an example, the Brisbane International Initiative has been set up to develop a comprehensive curriculum for primary care research training. In order to inform this process, the neglected concept of "development" was explored theoretically and through a small pilot study. A number of issues and concepts are highlighted that may assist in closing the gap between research and practice. These included the consideration of a range of skills not conventionally included in current research training curricula. It is argued that these "development" skills are essential in order to enhance the relevance of researchers' contributions in the highly complex and specialised field of primary care practice. A large international study is proposed to validate this skill set.

Closing the gap and widening the scope. New directions for research capacity building in primary health care.

BACKGROUND: Research capacity building initiatives abound within primary health care to increase the research base of the many component health professionals and organisations. Most initiatives aim to close the gaps between research, policy and practice. Many of these approaches have been unable to build the necessary skills among primary health care researchers to fully integrate research evidence into clinical practice, and ultimately to inform policy in this complex arena. OBJECTIVE: To propose a paradigm shift in the content of capacity building as a step toward closing the gaps between research, policy and practice. DISCUSSION: The complexity of the primary health care environment and the concept of development as a means to understanding and operating within primary health care research, policy and practice environments is discussed. A small pilot study was used to identify the underlying skills required in research, evaluation and development. In order to facilitate the paradigm shift an organisational development model was utilised that demonstrated congruency with this skill set. Further research is required to validate and apply this model in a primary health care research capacity building context.

Whiplash: still a pain in the neck.

BACKGROUND: Whiplash is a common problem, particularly following motor vehicle accidents and may have significant sequelae in terms of disability and financial compensation. Recent research has demonstrated that a number of commonplace medical practices as well as the compensation system may lead to unfavourable outcomes. OBJECTIVE: This article discusses recent research into whiplash and its implications for clinical practice. DISCUSSION: A full assessment of biopsychosocial factors in the acute phase of the injury is essential to predict those at risk of chronicity. Simple therapeutic and educational measures should be employed and early referral to a psychologist or pain specialist considered for those at high risk.

Grassroots research: how to have a stab at your first project and succeed.

BACKGROUND: Current initiatives are aimed at building the capacity within Australian primary care to undertake high quality research and evaluation, including clinicians who are not primarily researchers. OBJECTIVE: To provide a simple guide to encourage practice based research projects. TIPS AND ADVICE: Be parsimonious with the amount of data collected, ensure the literature is searched first, keep the project as simple as possible, invest time in planning and managing the project, readily ask for help and advice, and make every effort to publish the results. DISCUSSION: A modest, carefully supported and systematic approach is recommended for increasing the chance of success and quality of the research.

Re-thinking approaches to undergraduate health professional education: Interdisciplinary Rural Placement Program.

The Interdisciplinary Rural Placement Program involved the development, implementation and evaluation of a common rural primary health care module. Designed for undergraduate nursing, medical and pharmacy students of the University of Tasmania, students undertook clinical experiences and a collaborative primary health care project at two different Rural Health Teaching Sites across Tasmania. The aim of the project was for interdisciplinary students to work and learn together to enhance their understanding of the cooperative and collaborative nature of professional practice among rural health care workers. This paper will describe the development and implementation of the Interdisciplinary Rural Placement Program and critically discuss the outcomes in relation to nursing. In this paper, three issues will be explored. Firstly, how student nurses questioned their sense of subordination when in fact the level of recognition by their interdisciplinary peers led them to refute this. Secondly, concerns with overcoming the difficulties of coordinating student recruitment and conflicting timetables, while working within existing curricula, will be discussed. The final issue explores the student nurses' recognition that despite inherent tensions and conflict, the need to work as a cohesive and cooperative interdisciplinary team was vital. This project highlighted the challenges that health professions continue to work through in contemporary practice and education sectors. A key recommendation for education providers is that true interdisciplinary education must be achieved through an experiential framework.

Development of the special skills post in expedition medicine for general practice registrars in Australia.

Wilderness, mountain, and expedition medicine training for physicians is now well developed in North America and Europe. This paper describes the development and content of the first such program in Australia. The Special Skills Post in Expedition Medicine is a 6-month post, developed by General Practice Training Tasmania, that is integrated into general practice training and combines clinical placements in travel medicine, general practice, emergency medicine, a self-guided workbook covering core and elective topics, and an 8-day field trip.