An Institutional Evaluation of Race and Ethnic Diversity in Pre-clerkship Lectures.

The goal of this project was to assess the current state of racial and ethnic presentation in medical pedagogy using the pre-clerkship curriculum at Case Western Reserve University School of Medicine (CWRU SOM). We systematically reviewed 20,630 slides across the basic sciences curriculum from 2020 to 2022 for references to race, ethnicity, or photos of people of color. Results showed that race and ethnicity are overwhelmingly used as biological constructs and references lack appropriate historical context. In addition, this project constructed learning objectives that provide suggestions to shift medical discourse on race and ethnicity from contemplation to a state of solution.

Australian trampoline injury patterns and trends.

OBJECTIVES: To examine national trampoline injury patterns and trends in the context of improved product safety standards and trampoline design modifications. METHOD: Review of National Hospital Morbidity data. RESULTS: There were an average 1,737 trampoline injuries reported nationally each year from 2002 to 2011. Both injury frequency and rate grew. Statistically significant rate increases were observed among all age groups, although both are highest among children aged 5-9 years. From 2008/09 there is a possible decreasing trend among the 5-9 age group. Falls predominate and 81% of falls result in fracture. Non-fall injuries increased annually as a proportion of all hospitalised injury although they did not comprise more than 2.4% in any one year. CONCLUSIONS: History provides no evidence of an observable effect of voluntary Australian Standards for trampoline safety on population rates for trampoline injury. The major design modification--netted enclosures--could contribute to the risk of injury by leading parents to falsely believe that a netted enclosure eradicates the risk of injury.

Influence of voluntary standards and design modifications on trampoline injury in Victoria, Australia.

PURPOSE: To examine the influence of the voluntary Australian trampoline standard (AS 4989-2006) and market-driven design modifications on relevant trampoline injuries. METHODS: Trend and intervention analysis on frequencies and proportions of hospital-treated trampoline-related injury in Victoria, Australia, extracted from the Victorian Emergency Minimum Dataset from 1 July 1999 to 30 June 2013. The injuries relevant to the AS were contact with spring and frame, and multiple-user injury. Falls from trampolines were relevant for netted trampolines, a market-driven modification. RESULTS: Frequency of all trampoline injuries increased by 11.4% (95% CI 10.0% to 11.7%) on average each year. Spring and frame, and fall injuries increased to a lesser extent (8.7%, 95% CI 6.9% to 9.8% and 7.3%, 95% CI 5.8% to 8.3%, respectively). Multiple-user injuries increased by 21.0% (95% CI 16.3% to 21.9%). As a proportion of all trampoline injuries, spring and frame injury and falls injury decreased, while multiple-user injuries increased. The intervention analysis showed no significant change in spring and frame injuries associated with the AS (p=0.17). A significant increase was found for multiple-user injuries (p=0.01), in particular for the 0-year to 4-year age group (p<0.0001), post 2007. CONCLUSIONS: There was little evidence for an effect of the voluntary standard on spring and frame injury and none for multiple-user injury. Netted trampolines appear to be associated with a decrease in falls from trampolines but an increase in injuries to multiple users. A mandated trampoline safety standard and a safety campaign including warnings about multiple users is recommended. Continued monitoring of injury data will be required.

Partnering with public schools: a resident-driven reproductive health education initiative.

STUDY OBJECTIVES: To assess the impact of a resident-driven sexual health educational initiative in an inner-city Cleveland middle school. DESIGN, SETTING, AND PARTICIPANTS: 10 resident physicians and 57 students in 7(th) and 8(th) grade participated in this prospective cohort study. INTERVENTIONS AND MAIN OUTCOME MEASURES: Residents taught 3 sessions on the topics of basic anatomy and physiology, pregnancy, sexually transmitted infections (STI), contraception, and safe relationships. Outcome measures included the percentages of students able to name at least 3 different STIs and contraceptive methods; to name potential complications of STIs; and to correctly identify condoms and abstinence as the only contraceptive methods also protective against STI transmission. RESULTS: Significant improvements were noted in students' baseline knowledge of human anatomy, contraception, and safe sex practices after completion of the curriculum. The percentage of students able to name at least 3 forms of birth control increased from 1.7% to 70.7% (P < .0001). The percentage able to name at least 3 different STIs increased from 5.3% to 72.4% (P < .0001). Follow-up testing 4 months after completion of the curriculum demonstrated significant knowledge retention. All residents and medical students surveyed described a perceived need for comprehensive-rather than abstinence-based-reproductive health education in schools. CONCLUSIONS: The socioeconomic burden of teen pregnancy justifies comprehensive efforts to improve reproductive health education.

Changing epidemiology of intentional antidepressant drug overdose in Victoria, Australia.

AIM: To determine the epidemiology of intentional antidepressant drug overdose (OD), over an extended time period, in Victoria, Australia. METHODS: Retrospective epidemiological study of all cases reported to the Victorian Emergency Minimum Dataset (VEMD) January 1998 to December 2007 and calls to the Victorian Poisons Information Centre (VPIC) June 2005 to September 2008. RESULTS: 5467 VEMD cases were analysed. 3169 (57.9%) cases involved selective serotonin reuptake inhibitors (SSRIs) and 1149 (21%) involved tricyclic antidepressants (TCAs). Sertraline (1252, 22.9% cases) was the most common drug. During 2001, the peak year of OD, there were 8.8 OD/100 000 population in the SSRI group and 3.8 OD/100 000 population in the TCA group. Trends over the study period showed increasing SSRI and 'other' newer antidepressant prescription rates and decreases for TCA and monoamine oxidase inhibitors (MAOI). However, the risks of OD in all drug classes were similar and OD/100 000 prescriptions trended downwards for all drug classes over time. 1833 VPIC calls were analysed. Calls relating to SSRIs were the most common yet SSRI OD was associated with significantly fewer symptoms (p < 0.001) and fewer patients with Poisoning Severity Score classifications of moderate or severe (p < 0.01). CONCLUSIONS: Antidepressant OD patterns are changing. Antidepressant OD incidence is following prescribing trends. The risk of OD is similar for all drug classes. Absolute numbers of OD and OD/100 000 prescriptions are decreasing for all drug classes.

The epidemiology of burn injuries in an Australian setting, 2000-2006.

OBJECTIVES: To describe presentation characteristics of burn leading to death or hospital treatment (i.e. inpatient admissions and emergency department [ED] presentations) across the state of Victoria, Australia, for the years 2000-2006 inclusive. METHODS: Data were provided by the Victorian Injury Surveillance Unit (VISU) from three different datasets pertaining to burn deaths, hospital inpatient admissions and non-admitted ED presentations. Population estimates were derived from census data provided by Australian Bureau of Statistics. RESULTS: During the 7-year period, 178 people died and 36,430 were treated for non-fatal burn injury, comprising 7543 hospital admissions and 28,887 non-admitted ED presentations. Males, children aged less than 5 years of age, and the elderly (> or =65 years of age) were at the highest risk of injury. Contact with heat and hot substances represented the major aetiological factor contributing to thermal injuries accounting for 64% of all hospital admissions and 90% of ED presentations. Temporal trends indicate no change in the population rate of burn deaths or hospital admissions during the study period. CONCLUSIONS: ED presentations and hospital admissions and deaths have remained the same over this study period, but rates of burn remain high in males, children and the elderly. This could be due to variations in the implementation of government prevention and control programs and the divergence in efficient treatments and clinical practices amongst hospital care providers. Therefore, educational efforts for prevention should be the keystone to minimise the incidence of burns.

A randomized trial comparing 2 outpatient educational settings for clerkship students: private practice office vs hospital clinic.

OBJECTIVE: The purpose of this study was to compare medical students' experiences in 2 outpatient educational settings. STUDY DESIGN: For their 2-week ambulatory rotation, all 76 medical students were randomized to either a hospital clinic or a private office. Seventy students completed the survey. RESULTS: When compared to students working in a private office setting, hospital clinic students reported more breast exams, speculum exams, uterine fundal height measurements, wet mount reading, contraceptive counseling, and first obstetrical and gynecologic patient visits. Students in the hospital clinic were more likely to report having educationally valuable opportunities to interview and examine patients and to discuss the differential diagnosis with their preceptor. Nevertheless, medical students randomized to the private office were more likely to report considering obstetrics and gynecology as a career. CONCLUSION: The hospital clinic provided students with more clinical experiences. Medical students assigned to a private office, however, were more likely to consider obstetrics and gynecology as a career.

Animal and human bite injuries in Victoria, 1998-2004.

OBJECTIVE: To describe the epidemiology of mammal (human and non-human) bite injuries in Victoria. PARTICIPANTS, DESIGN AND SETTING: Retrospective case series of injuries recorded in the Victorian Emergency Minimum Dataset (VEMD) (1998-2004) and deaths recorded in the National Coroners Information System (1 July 2000 - 1 June 2006). MAIN OUTCOME MEASURES: Frequency, nature and outcome of injury as a function of mammal, victim demographics and season. RESULTS: Of 12 982 bite injuries identified in the VEMD, dogs, humans, and cats were implicated in 79.6%, 8.7%, and 7.2% of cases, respectively. Dog bite injuries were commonly sustained to the hands/wrists (31.3%) and face/head (25.4%); cat bites to the hands/wrists (67.6%) and arms (16.0%); and human bites to the hands/wrists (37.1%), arms (20.5%) and face/head (20.4%). Males comprised 73.7% and 56.3% of human and dog bite victims, respectively, while females comprised 64.1% of cat bite victims. A third of dog bite victims (33.4%) were children aged 14 years or less. Most human bite victims (79.8%) were adults aged 20-49 years, inclusive. More injuries were sustained on weekends and during the summer, 55.4% of injuries occurred in the home, and 11.6% of patients required hospital admission. Dog bites resulted in three deaths. CONCLUSIONS: Mammal bite injuries are common and often require inpatient care. Patterns of bite injuries relate to the type of mammal involved. These epidemiological data will inform prevention initiatives to decrease the incidence of mammal bites.

Victorian Emergency Minimum Dataset: factors that impact upon the data quality.

OBJECTIVE: The Victorian Emergency Minimum Dataset (VEMD) records details of approximately 80% of Victoria's ED presentations. Its usefulness for quality assurance and research relies on the data being both complete and accurate. We aimed to determine the factors that impact adversely on the collection of high-quality VEMD data. METHODS: The study was a voluntary, anonymous, cross-sectional survey of a range of ED staff (medical, nursing, clerical) who collect and enter data into the VEMD. Nine of the 28 hospitals that contribute to the VEMD were surveyed. The questionnaire was purpose-designed and self-administered. RESULTS: A total of 218 staff participated (response rate 95%). Six different software types were used, with 40% of respondents using the Pickware (MCAT) system. There was no consistency of ED personnel for the completion of specific data fields. One hundred and twenty-six (56%) respondents had heard of the VEMD, 67 (29%) had had its structure and purpose explained and 65 (30%) had been trained to enter data. Ninety-seven (45%) respondents knew what the VEMD data was used for, 38 (17%) knew they could request VEMD data for their own use and 17 (7.8%) had done so. Time constraints, software problems and lack of formal orientation and training in data entry were reported as the most important factors impacting adversely upon quality data entry. CONCLUSION: Staff knowledge of the VEMD system and its uses are poor. Numerous factors impact on the quality of data entered and interventions aimed at improving staff education, training and feedback and software are indicated.

Eye injury after jellyfish sting in temperate Australia.

Although jellyfish stings are an uncommon medical problem in temperate Australia, significant morbidity can occur, particularly in association with infestations of large numbers of jellyfish in public swimming areas. We report a case of a jellyfish sting-related eye injury, probably caused by the "hair" jellyfish (Cyanea capillata) from southeast Australia. The patient, a 54-year-old man, was stung while swimming without goggles in a jellyfish-infested bay. He experienced severe pain in his right eye, requiring narcotic analgesia, and had decreased visual acuity associated with right-sided facial swelling. Although usually brief and self-limiting, eye injuries after jellyfish stings should be assessed and treated as early as possible to reduce the risk of longer term sequelae. Water safety campaigns should incorporate information on the prevention and early treatment of such stings.

An analysis of marine animal injuries presenting to emergency departments in Victoria, Australia.

OBJECTIVE: To describe the epidemiology of marine animal injury in Victoria, Australia, in order to identify risk factors and recommend prevention strategies. METHODS: Retrospective, descriptive study of patients with marine animal injuries who presented to Victorian emergency departments between October 1995 and June 2000. Data were obtained from the Victorian Emergency Minimum Dataset. The main outcome measures were the marine animal involved; the nature, time, and place of injury; and subject demographics and activity. RESULTS: Two hundred five injuries were identified, and males predominated (71.7%, P < .01). Injuries were most frequent during summer and when jellyfish were most prevalent. Various fish species, stingrays, jellyfish, and sharks were incriminated in 83 (40.5%), 46 (22.4%), 42 (20.5%), and 5 (2.4%) injuries, respectively. Most (65.9%) injuries occurred during leisure or sport, and 72 (35.1%) occurred in a place of recreation. Spikes, spines, and barbs caused 82 (40.0%) injuries, and stings caused 54 (26.3%) injuries. Bites were uncommon. Most injuries were to the limbs, with the hands or feet injured in 127 (62.0%) patients. Forty (19.5%) injuries were associated with a retained foreign body. Only 17 (8.3%) patients required admission to the hospital. CONCLUSIONS: Marine animal injury is seasonal but rarely serious. Vigilance is required when handling fish, and protective gloves, footwear, and clothing are recommended where appropriate. Clinicians should consider retained foreign bodies in penetrating injuries. Warnings are recommended when jellyfish are most prevalent.