Impact of the Northern Studies Stream and Rehabilitation Studies programs on recruitment and retention to rural and remote practice: 2002-2010.

INTRODUCTION: A shortage of rehabilitation practitioners in rural and/or remote (rural/remote) practice areas has a negative impact on healthcare delivery. In Northern Ontario, Canada, a shortage of rehabilitation professionals (audiology, occupational therapy, physiotherapy, speech-language pathology) has been well documented. In response to this shortage, the Northern Studies Stream (NSS) and Rehabilitation Studies (RS) programs were developed with the mandate to increase the recruitment and retention of rehabilitation professionals to Northern Ontario. However, the number of NSS or RS program graduates who choose to live and work in Northern Ontario or other rural/remote areas, and the extent to which participation in these programs or other factors contributed to their decision, is largely unknown. METHODS: Between 2002 and 2010, a total of 641 individuals participated in the NSS and RS programs and were therefore eligible to participate in the study. Current contact information was obtained for 536 of these individuals (83.6%) who were eligible to participate in the study. An internet-hosted survey was administered in June of 2011. The survey consisted of 48 questions focusing on personal and professional demographics, postgraduate practice and experience, educational preparation, and factors affecting recruitment and retention decisions. RESULTS: A total of 280 respondents completed the survey (response rate 52%). Of these, 95 (33.9%) reported having chosen rural or remote practice following graduation. Multiple factors predictive of recruitment and retention to rural/remote practice were identified. Of particular note was that individuals raised in a rural or remote community were 3.3 times more likely to work in a rural or remote community after graduation. Recruitment was strongly associated with length of time immersed in rural/remote education settings and to participation in the NSS academic semester. Job satisfaction, professional networking opportunities, and rural lifestyle options were identified as important factors for retention in rural/remote practice areas. CONCLUSIONS: The NSS and RS programs have experienced encouraging recruitment outcomes in the past 10 years. Recruitment and retention of rehabilitation therapists to rural/remote locations appears to be positively and significantly affected by the origins of the health professional. The completion of both academic and clinical education in a rural/remote setting and longer duration of rural/remote education were positively associated with an increased likelihood of choosing to practice in a rural/remote area following entry to practice. These findings have potential implications for admission criteria to rehabilitation education programs with a rural curriculum focus as well as implications for postgraduate mentorship programs and employers in rural/remote areas.

Early post-convulsive prolongation of QT time in children.

AIM: An important differential diagnosis of seizures in childhood is the long QT syndrome. Childhood epilepsy occurs about 400 times more often than long QT syndrome. We had observed children with slight post-convulsive prolongation of QT time more often than the reported incidence of long QT syndrome. We therefore conducted a prospective study to define the characteristics of post-convulsive prolongation of QT time in children. METHODS: We investigated 30 consecutive infants and children (3 mo to 14 y) within 2 h after seizures. A follow-up ECG was obtained 1-9 d later. We also obtained ECGs from 30 healthy age- and gender-matched controls. We calculated the QT interval corrected for heart rate (QTc) by Bazett's formula in leads II, V5, V6, QT dispersion and the number of notched T waves. RESULTS: We found a QTc interval of more than 440 ms in one or more leads in the first ECG in seven of 30 infants and children compared to 1 of 30 in the follow-up ECG (p=0.0003) and two of 30 in the healthy controls (p=0.14). Average QTc was higher for all leads in the first ECG. This was statistically significant in leads II (414 vs 402 ms, p=0.008), V5 (416 vs 404 ms, p=0.002) and V6 (415 vs 399 ms, p=0.001). Compared to healthy controls, QT dispersion was slightly larger in the early post-convulsive ECG (36 vs 31 ms, p=0.03). Notched T waves occurred more frequently in the early compared to the late post-convulsive ECGs (p=0.009). CONCLUSION: Slight to moderate post-convulsive prolongation of the QT interval is not rare but transient in paediatric patients.