Tracking Australian health and medical research expenditure with a PubMed bibliometric method.

OBJECTIVE: To assess Australian health and medical research (HMR) investment returns by measuring the trends in HMR expenditure and PubMed publications by Australian authors. METHODS: Bibliometric analysis collating Australian HMR expenditure reported by the Australian Institute of Health and Welfare and Australian HMR publications indexed in PubMed. Similar methods were applied to data from the United Kingdom and New Zealand. RESULTS: From financial year 2000/01 through 2011/12, HMR investment increased by 232% from $1.49 to $4.94 billion (current prices adjusted for inflation), while PubMed publications increased by 123% from 10,696 to 23,818. The average HMR investment required for a single PubMed publication rose by 49% from $139,304 in 2000/01 to $207,364 in 2011/12. Quality analyses showed an increase in systematic reviews, cohort studies and clinical trials, and a decrease in publications in PubMed's core clinical journal collection. Comparisons with New Zealand and the United Kingdom showed that Australia has had the greatest overall percentage increase in gross publication numbers and publications per capita. CONCLUSIONS: Our analyses confirm that increased HMR expenditure is associated with an increase in HMR publications in PubMed. IMPLICATIONS: Tracking HMR investment outcomes using this method could be useful for future policy and funding decisions at a federal and specific institution level.

Large and forgotten in rural Australia: assessment, attitudes and possible approaches to losing weight in young adult males.

BACKGROUND: Young Adult Males (YAMs) in rural Australia are poorly studied with respect to overweight and obesity. Firstly, we explored the feasibility of recruiting 17-25 year old YAMs to obtain baseline data on overweight and obesity rates, socio-demographics, nutrition, exercise and mobile phone usage. Secondly, we explored the views of YAMs with a waist measurement over 94 cm about using mobile phone text messages to promote weight loss and incentives to promote healthy lifestyles. METHODS: A two-staged, mixed-methods approach was used to study obesity and overweight issues in Dubbo, a regional city in New South Wales, Australia. In Phase I, socio-demographic, health behaviour and mobile phone usage data were collected using a questionnaire and anthropometric data collected by direct measurement. In Phase II, YAMs' views were explored by focus group discussion using a semi-structured questionnaire. RESULTS: Phase I (145 participants): mean Body Mass Index (BMI) 25.06±5.01; mean waist circumference 87.4±15.4 cm. In total, 39.3% were obese (12.4%) or overweight (26.9%) and 24.1% had an increased risk of metabolic complications associated with obesity. 135 (93.1%) owned a mobile phone and sent on average 17±25 text messages per day and received 18±24. Phase II (30 participants): YAMs acknowledged that overweight and obesity was a growing societal concern with many health related implications, but didn't feel this was something that affected them personally at this stage of their lives. Motivation was therefore an issue. YAMs admitted that they would only be concerned about losing weight if something drastic occurred in their lives. Text messages would encourage and motivate them to adopt a healthy lifestyle if they were individually tailored. Gym memberships, not cash payments, seem to be the most favoured incentive. CONCLUSION: There is a clear need for an effective health promotion strategy for the almost 40% overweight or obese Dubbo YAMs. The high rate of text message usage makes it feasible to recruit YAMs for a prospective study in which personalized text messages are used to promote healthy behaviours. It may be important to target motivation specifically in any weight-related intervention in this group with incentives such as gym membership vouchers.

A multi-university evaluation of the rural clinical school experience of Australian medical students.

INTRODUCTION: Medical students have been attending rural clinical schools (RCSs) since 2001. Although there have been generally positive single institution reports, there has been no multi-institution study using a common survey instrument. The experiences of medical students who attended a number of RCSs during 2006 were evaluated using a rural-specific questionnaire. METHODS: Questionnaires were distributed to 166 medical students who had completed one year at the RCS of six participating universities across Australia, including the Universities of New South Wales, Melbourne, Tasmania, Adelaide, and Sydney, and the Australian National University, of whom 125 responded (75.3%). Students were asked to rate their level of agreement on 29 items concerning their overall RCS experience, skills development and clinical supervision experience. RESULTS: The majority of respondents (n = 107, 86%) stated they would go to the RCS again if they had their time over and almost two-thirds (n = 77, 64%) stated they would spend more time at the RCS if they could. All items evaluating the educational experience recorded greater than 80% agreement (indicating very positive perceptions of the RCS experience). For the items concerning skills development, the highest level of agreement related to developing procedural skills (n = 121, 97%). For items relating to clinical supervision the agreement rate exceeded 80%. The majority of students found supervisors approachable (n = 121, 97%), enthusiastic (n = 120, 96%) and respectful (n = 119, 95%). CONCLUSIONS: Students' experiences in the RCSs are unequivocally positive. Most importantly, the RCS environment was conducive to learning and the development of clinical skills, the students were able to see an adequate number of patients and were well-prepared for examinations, and their supervisors were very good and acted as positive role models. This augers well for the success of the RCS program and for its role in attracting future doctors to work in rural environments.

Aboriginal health worker screening for sexually transmissible infections and blood-borne viruses in a rural Australian juvenile correctional facility.

INTRODUCTION: In Australia, Aboriginal youth are disproportionately represented in juvenile detention centres. We assessed the prevalence of sexually transmissible infections (STIs) and blood-borne viruses (BBVs) identified by an Aboriginal Health Worker (AHW)-led screening program delivered to male detainees of a rural juvenile detention centre. METHODS: A retrospective review of first screening visit data was performed. Demographic and behavioural data were collected and the prevalence of STI/BBV was assessed. RESULTS: Over a 4-year period to November 2004, 101 screens on new medium-to-long-term detainees were performed. The median age of participants was 17 years (range 14-20) and 87% were Aboriginal. Most reported multiple lifetime sexual partners (mean 14, range 0-60) and a minority had used a condom for the last episode of vaginal intercourse. Injecting drug use and non-professional tattoos or piercings were both reported by over one-third of participants, with over 80% reporting previous incarceration. One-quarter of those screened were newly diagnosed with one or more STI/BBV. The most common infection identified was urethral chlamydia (prevalence 16.3%, 95% confidence interval 10.0-25.5%), although the prevalence of newly diagnosed syphilis, hepatitis B and hepatitis C were each over 5%. Many participants remained susceptible to hepatitis B. CONCLUSION: An AHW-led STI/BBV screening program identified a large number of asymptomatic and previously undiagnosed infections in this group of young male detainees. Such an education and screening program using skilled Aboriginal staff not affiliated with the correctional system could have a substantial impact on the prevalence of STI/BBV among juvenile detainees.

A ten-year retrospective study of unplanned hospital readmissions to a regional Australian hospital.

OBJECTIVE: To examine the trend in unplanned readmissions (URs) to Dubbo Base Hospital (DBH) over the period 1996-2005 and assess possible correlations with basic demographic data. RESULTS: URs increased over the study period, both as a total number and as a proportion of total admissions (from 4.7 to 5.4%), while average length of stay decreased from 5.3 to 4.4 days and available hospital beds decreased from 156 to 116. The proportion of URs for people aged 75 years has more than doubled over the same period. There were clear temporal variations in URs (greatest number occurring on Fridays and in late winter/early spring) and variations with age and gender (greatest number in young males; peaks for males in 0-10 and 71-80-year deciles and for females in 0-10, 21-30 and 71-80 year deciles). Fifty percent of URs occurred within 7 days of discharge. There was a statistically significant but small correlation between length of prior admission and time to readmission (Spearman correlation coefficient, 0.068; P < 0.01) although the time to readmission did not change over the study period. Chronic obstructive pulmonary disease (3.8%), complications of procedures (3.6%), heart failure and pneumonia (each 2.2%), angina (2.1%) and acute bronchiolitis (1.8%) were the top causes of URs. CONCLUSION: URs are becoming more frequent in DBH; analysis of associations and trends over time are the first step in determining targeted measures to address the problem.

Nationally consistent assessment of international medical graduates.

The need for consistency in assessing international medical graduates for work in Australia led the Council of Australian Governments, in 2006, to direct health ministers to implement a nationally consistent approach. An Implementation Committee was established in late 2006 to oversee the development of the new assessment process; the first steps were completed by July 2007 and further development will occur over the next 12 months. The pre-existing Australian Medical Council (AMC) examination pathway will continue to be available, and there will be two additional pathways for non-specialists. The pre-existing pathway for specialists is being revised. Elements that are being introduced include: standardised pre-employment assessment, including an off-shore screening examination; assessment of competence against a standardised position description and, if necessary, a structured clinical interview by an AMC-accredited provider before obtaining limited registration; orientation to the job, the Australian health care system and to communication and cultural issues; standardised supervision and supervisory reporting; a requirement for compulsory continuing professional development for reregistration; workplace-based assessment; assessment by an AMC-accredited provider before gaining full registration; and consistency of assessment for specialists by specialist colleges. Some elements have been operating in some jurisdictions from July 2007, and there is a commitment to full implementation in participating jurisdictions by July 2008.

The ARTS of risk management in rural and remote medicine.

INTRODUCTION: This paper describes an action research process (in which the researchers are active participants throughout the process of development, testing and refinement) to develop a framework for clinical risk assessment and management in the context of rural and remote medicine. The framework is needed to support educational, medicolegal and quality improvement processes in rural and remote medical practice. METHODS: The research process included identifying a problem and gradually developing a research question, developing a potential model for application in a specific context, refining the tool and piloting the tool in a limited context. The research question and framework were developed during a series of teleconferences under the aegis of the Censorial Panel of the Australian College of Rural and Remote Medicine (ACRRM). After the framework was developed and refined, it was tested at a workshop in conjunction with the ACRRM Scientific Forum in Alice Springs, Australia, in July 2004. Workshop participants were principally but not exclusively rural medical practitioners from across Australia. The main outcome measure was a working framework for risk management broadly applicable in rural and remote medicine. RESULTS: The process clarified differences between safety and quality approaches in metropolitan and rural and remote medical practice, culminating in an appropriate clinical risk management framework. CONCLUSION: The action research as undertaken resulted in a workable risk management framework that is worthy of further development and that may be a valuable educational tool, both for existing practitioners and for future rural doctors. Further, it has potential as a means of providing legal protection to rural practitioners when actual rural practice is at odds with "best practice" as defined by a metropolitan group of experts.

Retrospective bibliometric review of rural health research: Australia's contribution and other trends.

INTRODUCTION: The health of half of the world's 6 billion people and of the 6 million Australians living in rural and remote communities is demonstrably poorer than that of their metropolitan counterparts. As the existence of the discrete specialty of rural health (RH) is gaining acceptability worldwide, publications about RH issues are increasing in prevalence. We undertook a bibliometric analysis of Australian rural research trends and compared these with international RH research output, and analyzed how Australian RH research has been addressing the National Health Priority Areas (NHPAs) during this period. METHODS: Medline-listed publications from 1990 to 2005 relating to rural health or rural health services were downloaded using PubMed and written to a Microsoft Access database using specially developed software. Analysis was performed to determine the country of origin of the authors, frequency of journals, publication types and how publications addressed Australian NHPAs. RESULTS: We retrieved 20 913 rural health publications of which 1442 (6.8%) were from Australia. Analysis from 1990 and 2005 showed total world yearly publications increased from 410 to 1207, while the respective contribution from Australia increased from 17 (4.1%) to 198 (16.4%). Canadian and USA contributions increased respectively from 10 (2.4%) to 110 (9.1%) and 131 (32%) to 298 (24.7%). The top five journals that published RH articles were Journal of Rural Health (JRH; 453), Australian Journal of Rural Health (AJRH; 417), Medical Journal of Australia (MJA; 192), Social Science Medicine (191) and Lancet (171). The Australian journals with the largest number of RH publications were AJRH (374), MJA (177), Australian Family Physician (101), Rural Remote Health (55) and Journal of Telemedicine Telecare (54). The most frequent publication type was the journal article in all three countries. Australian publications comprised journal articles (85.1%), letters (9.1%), reviews (5.6%), editorials (4.7%) and clinical trials (2.9%). Australia had the lowest proportion of clinical trials of the three countries. Of the total 1290 Australian publications, 317 (25%) addressed the NHPAs. Of these, 118 (37.2%) addressed mental health, 54 (17%) cancer, 41 (12.9%) cardiovascular disease, 37(11.7%) injury prevention, 35(11%) diabetes and 15 (4.7%) arthritis and musculoskeletal conditions. DISCUSSION: Australia's contribution to the international RH literature is increasing, both in terms of the relative numerical contribution and the prominence of selected Australian journals as the destination for articles on RH topics. Of dedicated RH journals, AJRH is now almost as frequently used by authors as JRH. However the general journals Lancet, BMJ and MJA were also among the most frequent publishers of RH articles. Telemedicine and general practice journals (Australian Family Physician & Canadian Family Physician) were also among the top journals that published RH articles, which highlights the increasingly prominent role played by information and communication technologies in the delivery of rural health care in general practice settings. The most frequent NHPA addressed by the RH publications in Australia was mental health. However only approximately 1% of total Australian health publications from 1990 to 2005 addressed RH. There is still a pressing need for more RH research, particularly in health priority areas.

The effect of Web 2.0 on the future of medical practice and education: Darwikinian evolution or folksonomic revolution?

Web 2.0 is a term describing new collaborative Internet applications. The primary difference from the original World Wide Web is greater user participation in developing and managing content, which changes the nature and value of the information. Key elements of Web 2.0 include: Really Simple Syndication (RSS) to rapidly disseminate awareness of new information; blogs to describe new trends; wikis to share knowledge; and podcasts to make information available "on the move". The medical community needs to be aware of these technologies and their increasing role in providing health information "any time, any place".

Increased expenditure on Australian health and medical research and changes in numbers of publications determined using PubMed.

OBJECTIVE: To determine temporal trends in PubMed publications for Australian authors compared with changes in funding for health and medical research (HMR). DESIGN: Retrospective observational study. SETTING: Internet-based bibliometric study that collated Australian HMR expenditure from the Australian Institute of Health and Welfare and Australian (and other) research publications from PubMed. MAIN OUTCOME MEASURES: Australian expenditure on HMR and numbers of PubMed-cited publications from 1980 to 2004, with subgroup analyses for universities, clinical trials, and genetic and biotechnology research, and comparison with similar results from the United Kingdom and New Zealand. RESULTS: From 1980-81 to 2003-04, Australian HMR expenditure increased from $66 million to $1503 million and total Australian PubMed publications increased from 844 to 13 836. From 1995-96 to 2003-04, Australian publications for university-derived research and for clinical trials increased at a fairly constant rate. Genetic and biotechnology publications increased about fivefold (49 to 277) between 1990-91 and 2003-04. Between 1990 and 2004, total publications increased from 1754 to 3288 for New Zealand and from 12 401 to 19 600 for the UK. CONCLUSIONS: There is an association between increased funding for HMR and increased publications, as determined using PubMed, in the past 10 years. Using PubMed may be a simple way to track output from HMR expenditure.

Utilisation and clinical efficacy of echocardiography in a regional hospital.

OBJECTIVE: To determine utilisation and clinical efficacy of echocardiography in a regional setting. DESIGN: Consecutive patients referred for echocardiography studied prospectively using a pro-forma to be completed before and after echocardiography. SETTING: Regional hospital in New South Wales. PARTICIPANTS: A total of 103 consecutive patients. MAIN OUTCOME MEASURES: Utilisation and clinical efficacy of echocardiography. RESULTS: No significant abnormalities were detected in 41.7% of patients, but unexpected abnormalities were found in 31.1%. For 60% of pretest diagnoses there was a clinically important change in diagnostic certainty following the test and changes to treatment occurred in 30.1% of patients. A total of 19 patients with neurological events underwent echocardiography but none had cardiac thrombus demonstrated although thrombus was demonstrated in additional seven. CONCLUSIONS: Echocardiography appears to be used appropriately in our regional setting, resulting in major changes to diagnostic certainty and leading to alterations to treatments in almost one-third of patients. Education in relation to the use of echocardiography in patients with neurological events is warranted.

Development of a common national questionnaire to evaluate student perceptions about the Australian Rural Clinical Schools Program.

The Australian Commonwealth Department of Health and Ageing provided funds for the Australian medical schools to establish Rural Clinical Schools. This workforce initiative has enabled medical students to learn in a diverse range of rural and remote healthcare settings. A common questionnaire was developed and agreed on by all the directors of the Rural Clinical Schools. Use of this common questionnaire will facilitate reports on student attitudes and program outcomes, both within individual Rural Clinical Schools and at a national program level. The data analysis will inform the community and the Australian Government about the effectiveness of the national Rural Clinical School program in (1) meeting the primary aims of providing high quality rural medical education; and (2) addressing the medical workforce shortage in rural and remote areas.