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Background: Lack of patient access to family physicians in Canada is a concern. The role of recent physician graduates in this problem of supply of primary care services has not been established. We sought to establish whether career stage or graduation cohort were related to family physician practice volume and continuity of care over time. Methods: We conducted a retrospective cohort study of family physician practice from 1997/98 to 2017/18. We collected administrative health and physician claims data in British Columbia, Manitoba, Ontario and Nova Scotia. We included all physicians who registered with their respective provincial regulatory colleges as having a medical specialty of family practice or who had billed the provincial health insurance system for patient care as family physicians, or both. We used regression models to isolate the effects of 3-year categories of years in practice (at all career stages), time period and cohort on patient contacts and physician-level continuity of care. Results: Between 1997/98 and 2017/18, the median number of patient contacts per provider per year fell by between 515 and 1736 contacts in the 4 provinces examined. Median contacts peaked at 27-29 years in practice in all provinces, and median physician-level continuity of care increased until 30 or more years in practice. We found no association between graduation cohort and patient contacts or physician-level continuity of care. Interpretation: Recent cohorts of family physicians practise similarly to their predecessors in terms of practice volumes and continuity of care. Because family physicians of all career stages showed declining patient contacts, we suggest that system-wide solutions to recent challenges in the accessibility of primary care in Canada are needed., Access to primary care services in Canada falls short of comparable countries. (1) Despite increasing absolute numbers of family physicians, (2) evidence suggests that the volume of patient contacts and [...]

Background: Student choice is an important determinant of the distribution of specialties of practising physicians in many countries. Understanding characteristics at entry into medical school that are associated with the choice of residency in family medicine can assist medical schools in admitting an appropriate mix of students to serve the health care needs of their regions. Methods: From 2002 to 2004, we collected data from students in 15 classes at 8 of 16 Canadian medical schools at entry. Surveys included questions on career choice, attitudes to practice and socio-demographic characteristics. We followed students prospectively with these data linked to their residency choice. We used multiple logistic regression analysis to identify entry characteristics that predicted a student's ultimate career choice in family medicine. Results: Of 1941 eligible students in the participating classes, 1542 (79.4%) contributed data to the final analyses. The following 11 entry variables predicted whether a student named family medicine as his or her top residency choice: being older, being engaged or in a long-term relationship, not having parents with postgraduate university education nor having family or close friends practicing medicine, having undertaken voluntary work in a developing nation, not volunteering with elderly people, desire for varied scope of practice, a societal orientation, a lower interest in research, desire for short postgraduate training, and lower preference for medical versus social problems. Interpretation: Demographic and attitudinal characteristics at entry into medical school predicted whether students chose a career in family medicine., The number of physicians per capita in both Canada and the United States has declined, and this decline is expected to continue. Canada has already experienced a drop of 5.1% [...]

Background: Studies indicate that a student's career interest at medical school entry is related to his or her ultimate career. We sought to determine the level of interest in emergency medicine among students at the time of medical school entry, and to describe characteristics associated with students primarily interested in emergency medicine. Methods: We surveyed students in 18 medical school classes from 8 Canadian universities between 2001 and 2004 at the commencement of their studies. Participants listed their top career choice and the degree to which a series of variables influenced their choices. We also collected demographic data. Results: Of 2420 surveys distributed, 2168 (89.6%) were completed. A total of 6.1% (95% confidence interval 5.1%-7.1%) of respondents cited emergency medicine as their first career choice. When compared with students primarily interested in family medicine, those primarily interested in emergency medicine reported a greater influence of hospital orientation and a lesser influence of social orientation on their career choice. When compared with students primarily interested in the surgical specialties, those primarily interested in emergency medicine were more likely to report medical lifestyle and varied scope of practice as important influences. When compared with students primarily interested in the medical specialties, those who reported interest in emergency medicine were more likely to report that a hospital orientation and varied scope of practice were important influences, and less likely to report that social orientation was important. Conclusion: Students primarily interested in emergency medicine at medical school entry have attributes that differentiate them from students primarily interested in family medicine, the surgical specialties or the medical specialties. These findings may help guide future initiatives regarding emergency medicine education. Keywords: education, medical, undergraduate, career choice, specialties, emergency medicine, medical student, medical school Contexte : Des etudes revelent l'existence d'un lien entre le domaine professionnel qui interesse l'etudiant au moment de son entree a la faculte de medecine et la carriere qu'il choisit au final. Nous avons voulu determiner le degre d'interet a l'endroit de la medecine d'urgence chez les etudiants au moment de leur entree a la faculte de medecine et decrire les caracteristiques de ceux qui manifestaient un interet particulier pour ce domaine. Methodes : Nous avons realise un sondage aupres d'etudiants inscrits a 18 cours de medecine de 8 universites canadiennes entre 2001 et 2004, au debut de leurs etudes. Les participants ont dresse la liste de leurs preferences en matiere de choix de carriere et indique a quel degre une serie de variables influait sur leurs choix. Nous avons aussi recueilli des donnees demographiques. Resultats : Sur les 2420 questionnaires distribues, 2168 (89,6 %) ont ete remplis. En tout, 6,1 % (intervalle de confiance a 95 % de 5,1 a 7,1 %) des repondants ont classe la medecine d'urgence au premier rang parmi leurs choix de carriere. Comparativement aux etudiants qui s'interessaient principalement a la medecine familiale, les repondants attires surtout par la medecine d'urgence ont mentionne que l'orientation hospitaliere avait eu plus d'influence que l'orientation sociale sur leur choix de carriere. Comparativement aux etudiants qui s'interessaient principalement a la chirurgie, les repondants attires surtout par la medecine d'urgence etaient plus susceptibles de mentionner le mode de vie et la diversite associes a cette pratique comme facteurs ayant influe sur leur choix. Comparativement aux etudiants qui s'interessaient principalement aux specialites medicales, les repondants attires surtout par la medecine d'urgence etaient plus susceptibles d'affirmer avoir ete influences par l'orientation hospitaliere et la diversite de la pratique et moins susceptibles d'accorder de l'importance a l'influence de l'orientation sociale. Conclusion : Les etudiants qui s'interessent principalement a la medecine d'urgence lorsqu'ils entrent a la faculte de medecine presentent des caracteristiques qui les distinguent des etudiants attires davantage par la medecine familiale et les specialites chirurgicales ou medicales. Ces observations pourraient servir a guider d'eventuelles initiatives touchant la formation en medecine d'urgence., INTRODUCTION Emergency medicine is a relatively new specialty in Canada with 2 routes of certification. The first Canadian emergency medicine certification exams were held by the College of Family Physicians [...]

The author suggests the creation of a national registry of percutaneous coronary intervention (PCI) that would prospectively collate standardized data on processes and outcomes of the procedure. Such a registry would guarantee the safe and suitable evidence-based use of limited resources for the use of PCI in real-world clinical practice rather than randomized trials.

Modern medicine in Australia has much to its credit, but it is creating an insatiable demand for new technologies and more health services, fed by commercial promotion, professional advocacy and sociopolitical pressure. A change in the thinking of practicing clinicians and policy-makers is essential if current medical practice is to avoid imploding when confronted with the next major economic downturn.

A study aims to raise awareness of potential pitfalls of public reporting and to suggest ways by which public reports, which focus on outcomes derived from administrative data could be rendered more beneficial and less harmful in improving hospital practice. Available research suggests that primary data sources are often inaccurate and incomplete, that reports have low predictive value in detecting outlier hospitals, and that users experience difficulty in accessing and interpreting reports and trend to distrust their findings.

Abstract Malignantperipheral nerve sheath tumors are uncommon lesions that occasionally affect the head and neck. We describe 2 new cases of head and neck pathology. One tumor involved the parotid [...]

A study of 607 patients admitted to community general hospitals with acute myocardial infarction (AMI) showed that patients were more likely to die or have another heart attack if they were not given care according to clinical practice guidelines.

Quality improvement interventions including regular practice review, clinical practice guidelines and feedback to staff can lower the risk of inhospital death for patients experiencing acute heart attacks. A before-and-after study at Queensland public hospitals showed that the risk of death was lower at a hospital that carried out quality improvement interventions as compared to hospitals with revascularization facilities or hospitals where the admitting doctor was a cardiologist.

A new study investigates the effects of revascularisation and coronary angiography in the subacute phase of acute myocardial infarction.

An overview is presented on intensive care nursing practice for the elderly and its appropriateness, effectiveness and safety. Topics include the risk of injury, such as a fall, patient confusion over changes in diet or medications, and other complications.

An alternative view on hospitals and physicians who might staff them on a fulltime basis as a speciality is presented by two members of the Internal Medicine Society of Australia and New Zealand representing that society asserting that general physicians should attend patients from admission into ambulatory care. The suggestion is that a hospitalist would need breadth of knowledge about multiple medical and surgical conditions and interactions of problems in various organ systems. Intensivists, although they possess expertise in certain emergency procedures, are not experts in the nonemergency and chronic care of multisystem disease and lack presence at the hospital/community care interface.

Two fatal cases of human melioidosis, an infectious disease of animals and humans caused by the gram-negative bacillus Burkholderia pseudomallei endemic to Southeast Asia, the South Pacific, and tropical/subtropical parts of Australia, are discussed. The cases occurred simultaneously in temperate southeast Queensland in Australia after an unseasonably heavy rainfall. The patients both had cutaneous lesions before illness onset and pre-existing multisystem illnesses and both died from overwhelming sepsis. Endemicity may extend into more temperate areas.

The author explains the various changes that need to be made in the hospitals, as per the report published by the National Health and Hospitals Reform Commission (NHHRC). He says that the subacute, as well as the non-acute services should be expanded and enhanced for increasing the standards of the hospital.

Several non-inferiority trials are conducted to determine the efficiency and the effectiveness of the new treatments, as compared to the alternative conventional ones. The analysis suggests that proper precautions should be exercised while implementing new exercises, as they are shown to be less effective and accurate than the established treatments.

The article discusses that there is a necessity to improve the quality of health care being meted out to patients in Australia. The only way that it can be improved is by measuring, monitoring and acting on health performance data.

A study is conducted to compare results of process-control analyses of in-hospital deaths of patients suffering from acute myocardial infarction and to assess the differences in results based on the patient's characteristics. Findings conclude that appropriate patient selection is more important than risk-prediction or dataset model for process-control analyses.

The aim of the study is to examine the relation between treatment intensity and the level of risk involved in hospital care of patients suffering from acute coronary syndromes (ACS). The results conclude that in the care of ACS, high-risk patients receive treatment more infrequently than those at low or moderate risk.

The article examines a new Pay for Performance (P4P) health care experiment presently underway in Australia, the possible impact it may have on the less privileged and presents its pros and cons.

The variation in the rates of use of key evidence-based therapies and in clinical outcomes among patients hospitalized with acute coronary syndromes (ACS) is identified. The findings indicate that variations exist in the provision of indicated care to patients with ACS according to age, diabetic status, renal function and type of admitting hospital.

The physicians should not depend on intuition and guesses during diagnosis or prognosis. The physicians face the problem of quantifying risk of disease and to overcome this problem, they should use validated decision-rule, scoring scheme or other numerical aids, which are easily available and are compatible with hand-held computers.

The methods of a collaboration of Queensland public hospitals involved in optimizing care of patients with acute cardiac conditions are evaluated. It is concluded that quality-improvement interventions conducted as multisite collaborations improve the in-hospital care to a considerable degree.

The patient participation rates in outpatient cardiac rehabilitation (OCR) programs, the barriers to participation and OCR program's quality are evaluated. The results show that there is significant underutilization of facility-based OCR programs in Queensland, Australia and procedures for identifying and referring eligible patients to existing programs and improving program compliance is required.

Common chronic diseases associated with mild disability that are seen in older people includes arthritis, hypertension, ischaemic heart disease and diabetes mellitus. The prevention and management of the chronic illness in older people are highlighted.d

The wreckage of a dozen crashed cars greeted drivers along a quarter mile stretch of the main Dublin-Belfast road north of Dundalk in February. The display on the hard shoulder [...]

A Florida company has recalled about 6600 girls' sweatshirts because they have hood drawstrings. Children can get entangled and strangle in the drawstrings that catch on objects, including playground equipment, [...]

Associated with the risk of injury death there is evidence that the life expectancy among Australian indigenous communities is falling. Unpublished data from the Australian Bureau of Statistics (ABS) indicates [...]

A new book puts the cost of gun violence in the US at a staggering $100 billion annually. Authors Phil Cook and Jens Ludwig, professors of public policy at Johns [...]

Soaring prices (by Canadian standards) for natural gas, oil, and electricity this winter led some Canadians to turn to alternative sources to heat their homes. (Compared with European prices, Canadian [...]

A recent study by the Yale School of Medicine found that slipping showers, loose throw rugs, and other household hazards were not responsible for most falls by the elderly living [...]

Survivor advocates and injury prevention professionals can form productive partnerships. The latest issue of the Trauma Foundation's newsletter describes seven examples of effective partnering that have resulted in the passage [...]

The Injury Prevention Research Unit at the University of Otago has produced more of its fact sheets on injury. Fact sheets No 17 Trends in Fatal Injury and No 18 [...]

There have been some significant changes in the New Zealand system of accident insurance. The accident compensation scheme provides 24 hour, no-fault, comprehensive, and compulsory accident insurance for all, including [...]

Following the model of successful campaigns in Australia, Norway, the US, and the province of British Columbia, Safe Kids Canada made tap water scalds the focus of its annual media [...]

How do you easily tell when playground surfacing material needs topping up? The government agency responsible for public playgrounds in the Australian Capital Territory came up with an idea that [...]

The Canadian Institute of Child Health has published the third edition of The Health of Canada's Children, which provides a comprehensive picture of child health and [...]

Inexpensive jewellery, often marketed for children, may contain extremely high proportions of lead, a marketplace survey by Health Canada discovered. Laboratory results showed that most of the jewellery, both imported [...]

Two new resources are available on agricultural injuries from the National Children's Center for Rural and Agricultural Health and Safety in Wisconsin. Their winter newsletter has a cover article 'Farm [...]

The ANEC Newsletter reports that on 30 November 2000, the Internal Market/ Consumer/Tourism Council of the European Union (EU) reached political agreement on the commission's draft directive to improve the [...]

In its most recent report, the US CPSC stated in 1991 that more than 100 000 cases of facial trauma occurred in children younger than 14 while they participated in [...]

In view of the 42 000 people killed and more than 1.7 million injured on EU roads every year, the European Parliament's Committee on Regional Policy has asked the commission [...]

Between July and December 2000, the US National SAFE KIDS Campaign conducted an extensive analysis of child occupant protection laws in all 50 states and the District of Columbia SAFE [...]

The Malaysian Ministry of Health appointed Dr R Krishnan, Dr Zulkifli Ismail, Dr Osman Ali, Dr Siti Norazah, Dr Loh Wah Yun, Dr K G Rampal, and Dr Amar Singh [...]

The Canadian Injury Research Network (CIRnet) continues on its fast track to create a research agenda for injury prevention and control, following the Canadian Conference on Injury Prevention and Control [...]