Summer in the country: changes in medical students' perceptions following an innovative rural community experience.

PURPOSE: The University of Missouri School of Medicine developed the Summer Community Program through which rising second-year medical students work alongside rural, community-based physician preceptors. This program is part of a comprehensive, longitudinal pipeline designed to increase student interest in rural practice. The authors describe the Summer Community Program, explain changes in students' perceptions of rural practice and rural lifestyle post program, and report participants' specialty choices and first practice locations. METHOD: The authors analyzed 229 participant responses (1996-2010) to pre- and postexperience questionnaires focused on perceptions of rural practice and lifestyle. The authors calculated the likelihood of participants matching into primary care compared with nonparticipants and analyzed participants' first practice locations. RESULTS: After the experience, participants' perceptions toward rural practice and lifestyle changed favorably, and 72% (n=208) reported more interest in rural practice. Compared with nonparticipants, summer participants were more likely to enter a primary care residency (relative risk [RR]=1.31; 95% confidence interval [CI]: 1.12-1.50) and twice as likely to choose specifically family medicine (RR=2.21; 95% CI: 1.68-2.88). Forty-six percent (n=78) of participants chose rural locations for their first practices. CONCLUSIONS: This program has positively influenced students' perceptions of rural practice and lifestyle and increased their interest in rural practice. Participants entered primary care and family medicine residencies at higher rates than nonparticipants, and nearly half started their medical practices in rural locations. Replicating this program may increase interest in rural medicine and address rural physician workforce needs.

Influencing residency choice and practice location through a longitudinal rural pipeline program.

PURPOSE: The University of Missouri School of Medicine developed the Rural Track Pipeline Program (MU-RTPP) to increase the supply and retention of rural physicians statewide. The MU-RTPP features a preadmissions program for rural students (Rural Scholars), a Summer Community Program for rising second-year students, a six-month Rural Track Clerkship (RTC) Program for third-year students, and a Rural Track Elective Program for fourth-year students. The purpose of this study is to report the specialty choices and first practice locations of Rural Scholars, RTC-only participants, and Rural Track Clerkship Plus (RTC+) participants (students who participated in the RTC Program plus an additional MU-RTPP component). METHOD: The authors compared the residency specialty choices of 48 Rural Scholars (tracked since 2002) with those of 506 nonparticipants and the residency specialty choices of 83 RTC participants and 75 RTC+ participants (tracked since 1997) with those of 840 nonparticipants. The authors calculated the relative risk (RR) for the likelihood of participants matching into primary care compared with nonparticipants and analyzed first practice location. RESULTS: Rural Scholars were more than twice as likely to match into family medicine (RR=2.6; 95% confidence interval 1.5-4.4). RTC and RTC+ participants entered primary care, especially family medicine, at rates significantly higher than nonparticipants. Over 57% of students who participated in the RTC program (and potentially other MU-RTPP offerings) chose a rural location for their first practice. CONCLUSIONS: The longitudinal MU-RTPP successfully recruits students for rural and primary care practice to address the health care needs of Missouri.

Clindamycin for vaginosis reduces prematurity and late miscarriage.

Using oral clindamycin to treat women with asymptomatic bacterial vaginosis during their second trimester (between 12 and 22 weeks estimated gestational age) reduces the number of premature births and late miscarriages. The study did not demonstrate a difference in the number of neonatal intensive care unit admissions, mean birth weight, or gestational age. This is the first study demonstrating benefits in treating asymptomatic bacterial vaginosis early in pregnancy. It still needs to be determined, in larger trials, whether generalized screening and treatment for asymptomatic bacterial vaginosis in the early second trimester is beneficial and cost-effective.

ACE inhibitors are better than diuretics for treatment of hypertension in the elderly.

Despite similar reductions in blood pressure, angiotensin-converting enzyme (ACE) inhibitors demonstrate lower combined rates of cardiovascular events or all-cause mortality in elderly hypertensive patients compared with diuretics. This benefit is most evident in men. These results may differ from those of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT) trial because that study included younger patients, had a greater representation of patients with African ancestry, used different brands of medication, and had a slightly different primary outcome. Despite these differences, both treatments offer an inexpensive means for reducing blood pressure and preventing hypertension-related complications.

Children with fever and vomiting benefit from immediate antibiotics for acute otitis media.

Starting antibiotics immediately in children with acute otitis media accompanied by fever or vomiting results in better symptom relief and decreased sleep disturbance when measured after 3 days, as compared with no treatment. Parents who consider these outcomes important may prefer not to delay antibiotic treatment. Conversely, children without fever or vomiting tend to have the same duration of symptoms regardless of antibiotic treatment and are suitable for a "wait and see" approach.