The Cardiac Complications of Methamphetamines.

Methamphetamines are increasingly popular drugs of abuse in Australia, and are rising in purity. The rising popularity and purity of methamphetamines has notably increased demands upon Australian medical services. Methamphetamines are sympathomimetic amines with a range of adverse effects upon multiple organ systems. Cardiovascular complications are the second leading cause of death in methamphetamine abusers, and there appears to be a high prevalence of cardiac pathology. Cardiovascular pathology frequently seen in methamphetamine abusers includes hypertension, aortic dissection, acute coronary syndromes, pulmonary arterial hypertension and methamphetamine-associated cardiomyopathy. The rising prevalence of methamphetamine abuse is likely to increase the burden of cardiovascular pathology in Australians. A National Parliamentary Enquiry was opened in March 2015 to address concerns regarding the medical and social impacts of methamphetamine abuse. From April 2015, a National 'Ice Taskforce' was also created in parallel. Reversal of cardiac pathology appears to be achievable with abstinence from methamphetamines and initiation of appropriate treatment. It is key to appreciate that the pathogenesis of methamphetamine-induced cardiac complications arises as a result of the specific toxic effects of methamphetamines. Clinical management is hence individualised; suggested management approaches for methamphetamine-induced cardiac complications are detailed within this article.

Use of a checklist during observation of a simulated cardiac arrest scenario does not improve time to CPR and defibrillation over observation alone for subsequent scenarios.

THEORY: Immersive simulation is a common mode of education for medical students. Observation of clinical simulations prior to participation is believed to be beneficial, though this is often a passive process. Active observation may be more beneficial. HYPOTHESES: The hypothesis tested in this study was that the active use of a simple checklist during observation of an immersive simulation would result in better participant performance in a subsequent scenario compared with passive observation alone. METHODS: Medical students were randomized to either passive or active (with checklist) observation of an immersive simulation involving cardiac arrest prior to participating in their own simulation. Performance measures included time to cardiopulmonary resuscitation (CPR) and time to defibrillation and were compared between first and second scenarios as well as between passive and active observers. RESULTS: Seventy-nine simulations involving 232 students were conducted. Mean time to CPR was 18 seconds (SD = 11.6) for those using the checklist and 24 seconds (SD = 15.8) for those who observed passively (M difference = 6 seconds), t(35) = 1.46, p =.153. Time to defibrillation was 94 seconds (SD = 26.4) for those using the checklist and 92 seconds (SD = 23.8) for those who observed passively (M difference = -2 seconds), t(38) =.21, p =.837. Time to CPR was 24 seconds (SD = 15.8) for passive observers and 31 seconds (SD = 21.0; M difference = 7 seconds), t(35) = 1.13, p =.265, for their first scenario counterparts. Time to CPR was 18 seconds (SD = 11.6) for active observers and 36 seconds (SD = 26.2; M difference = 18 seconds), t(24) = 2.81, p =.010, for their first scenario counterparts. Time to defibrillation was 92 seconds (SD = 23.8) for passive observers and 125 seconds (SD = 32.2; M difference = 33 seconds), t(33) = 3.63, p =.001, for their first scenario counterparts. Time to defibrillation was 94 seconds (SD = 26.4) for the active observers and 132 seconds (SD = 52.9; M difference = 38 seconds), t(28) =.46, p =.008, for their first scenario counterparts. CONCLUSIONS: Observation alone leads to improved performance in the management of a simulated cardiac arrest. The active use of a simple skills-based checklist during observation did not appear to improve performance over passive observation alone.

Change in foot strike patterns and performance in recreational runners during a road race: A cross-sectional study.

OBJECTIVES: To characterise foot strike and observe change in foot strike patterns with increasing distance during a 15km recreational running road race. To assess the impact of foot strike on running performance. DESIGN: Observational cross-sectional study. METHODS: Foot strike patterns were determined at the 3km and 13km checkpoints for 459 participants during the 2017 Melbourne City to Sea recreational running event. Foot strike patterns were categorised as either rearfoot strike (RFS) or non-rearfoot strike (NRFS) at both checkpoints and analyses were conducted on intra-individual change in foot strike as well as relationship to finishing time. RESULTS: The most prevalent foot strike pattern at 3km and 13km was RFS with 76.9% (95% CI: 73.2%-80.5%) and 91.0% (95% CI: 88.7%-93.1%) using this pattern, respectively. Of the 105 participants who ran with a NRFS at 3km, 61% changed to RFS at 13km. Race completion time differed by foot strike pattern, where mean time for consistent NRFS (62.64±11.20min) was significantly faster than consistent RFS (72.58±10.84min; p<0.001) and those who changed from NRFS to RFS between checkpoints (67.93±10.60min; p=0.040). CONCLUSIONS: While the majority of recreational distance runners RFS within race settings, the fastest runners were those who consistently ran with a NRFS. In runners that use a NRFS early, a large proportion change to RFS as distance increases. Further research is warranted to determine whether interventions aimed at reducing muscular fatigue can attenuate this change and enhance running performance.

Review article: Isolated proximal tibiofibular joint dislocation.

Proximal tibiofibular joint (PTFJ) dislocations are relatively rare injuries and this paper provides an up-to-date review and practical management approach for the assessment and management of these cases. Isolated PTFJ dislocations are a rare injury, accounting for less than 1% of all knee injuries. Thus, there does not appear to be a clear consensus on definitive management and post-reduction care in the literature. This paper provides a review of the literature, anatomical analysis of the PTFJ in the dislocated state, and a technique for reduction. In the majority of cases, PTFJ dislocations are an injury that can be identified with simple imaging modalities and treated in the ED with manipulation under procedural sedation.

Intensive simulation versus control in the assessment of time to skill competency and confidence of medical students to assess and manage cardiovascular and respiratory conditions-a pseudo-randomised trial.

BACKGROUND: The Clinical Placement Enhancement Program (CPEP) is a simulation course for medical students learning the core topics of cardiovascular and respiratory medicine, incorporating patient safety and professionalism teaching and based on adult learning principles and proven educational theory. The aims of this study are to assess whether the CPEP delivered at the beginning of a clinical rotation would result in competency outcomes that are at least equivalent to those achieved through a standard 6-week programme and whether this programme would increase student confidence levels in assessing and managing patients with cardiovascular and respiratory conditions. METHODS: This was a pseudo-randomised control trial between two groups of medical students from one clinical school. The intervention group participated in CPEP, a 4-day immersive simulation course, in the first week of their cardiac and respiratory medicine clinical rotation. The control group participants attended the normal programme of the 6-week cardiovascular and respiratory medicine clinical rotation. The programme and student competence was assessed using Observed Structured Clinical Examinations (OSCEs) and self-reported confidence surveys. RESULTS: There was no significant difference in OSCE scoring between the intervention group (examined in week one of their clinical rotation following CPEP) and the control group (examined at the end of their full clinical rotation). Students exposed to CPEP started their clinical rotation with confidence levels similar to those reported by the control group at the end of their rotation. Confidence levels of CPEP students were higher at the end of the rotation compared to those of the control group. CONCLUSIONS: Based on OSCE results, immersion into a 4-day simulation-based teaching programme at the start of a clinical rotation resulted in skill competency levels that were equivalent to those obtained after a full clinical rotation of 6 weeks. CPEP improved students' confidence levels in the assessment and management of patients presenting with cardiovascular and respiratory conditions. Simulation utilised in courses such as CPEP has the potential to enhance the overall learning experience in medical school clinical rotations.

Techniques for reduction of anteroinferior shoulder dislocation.

Dislocation of the shoulder joint is common. The shoulder is affected in up to 60% of all major joint dislocations, one study citing an incidence of 1.7% in the general population. The most common form is anteroinferior dislocation. A variety of techniques to reduce shoulder dislocation has been described. The key to successful relocation is a thorough understanding of the anatomy of both the enlocated and the dislocated shoulder joint.