The need for a specialized clinical regimen for patients with dementia who require palliative care has only recently been recognized. Structured approaches to palliative care are not well developed. The recognition and treatment of pain is an important part of this management risk. However, pain is consistently underdiagnosed and undertreated in this population. A factor contributing to this has been a lack of appropriate tools to help recognize and document pain. This study sought to develop and validate an easy-to-use pain scale for use in residential aged care homes. The tool was developed with residents with end- or late-stage dementia who were unable to articulate their needs, identified by the registered nurses who knew them. Results showed that following pain-relief intervention the average pain score recorded using the scale fell by more than half. A paired Student's t-test showed the reduction to be highly significant (P<0.001). Validity and internal reliability, assessed by calculating Gamma and Cronbach's alpha, were found to be satisfactory. Qualitative evidence gathered from users of the scale indicated that it was considered a useful clinical device that could be completed within one minute. Further analysis of the use of the scale in clinical settings, testing of inter-rater reliability and examination of the limitations found in this study will commence early in 2004.

Training health professionals in smoking cessation.

Objectives To determine whether moving clinical medical education out of the tertiary hospital into a community setting compromises academic standards. Design Cohort study. Setting Flinders University four year graduate entry medical course. In their third year, students are able to choose to study at the tertiary teaching hospital in Adelaide, in rural general practices, or at Royal Darwin Hospital, a regional secondary referral hospital. Participants All 371 medical students who did their year 3 study from 1998-2002. Main outcome measures Mean student examination score (%) at the end of year 3. Results The unadjusted mean year 3 scores at each location differed significantly (P < 0.001); the mean score was 65.2 (SE = 0.43) for Adelaide students, 68.2 (0.83) for Darwin students, and 69.3 (0.97) for students on the rural programme. Mean year 2 scores were similar for each location. Post hoc tests of means adjusted for sex, age, year 2 score, and cohort year showed that the rural and Darwin groups had a significantly improved score in year 3 compared with the Adelaide group (adjusted mean difference = 3.08, 95% confidence interval 1.25 to 4.90, P < 0.001 for rural group; 1.91, 0.47 to 3.36, P = 0.001 for Darwin group). Conclusions These findings show that the concern that student academic performance in the tertiary hospital would be better than that of students in the regional hospital and community settings is not justified. This challenges the orthodoxy of a tertiary hospital education being the gold standard for undergraduate medical students.

Study Design: Prospective cohort study. Objective: To examine clinical and magnetic resonance imaging (MRI) features of hamstring muscle injury to determine if any are predictive for recurrent injury. Background: Hamstring muscle strain injury and subsequent recurrent injury are common. Little information exists on factors that may increase the risk for recurrent injury. Methods and Measures:The subjects were athletes from 3 professional Australian Rules football teams (n = 162). Anthropometric measurements, clinical signs, convalescent interval, and MRI assessment and measurement were undertaken and recorded in athletes with hamstring muscle strain injury. Athletes were followed for the presence, or absence, of recurrent injury to the same-side posterior thigh over the same and subsequent playing seasons. Results: Thirty athletes met criteria for hamstring injury. Twelve (40%) of 30 athletes had recurrent injury within the same season, with an additional 7 athletes having recurrent injury in the subsequent season. None of the features examined were associated with increased recurrent injury risk within the same playing season. Statistical analysis demonstrated that when combining the same with the subsequent playing season a larger size of initial hamstring injury, as measured by MRI, was associated with an increased risk for recurrent injury (P Ͻ .01). A measured transverse size of injury greater than 55% of the muscle, or calculated volume of injury greater than 21.8 cm 3 , resulted in an increased risk for hamstring recurrence of 2.2 (95% CI, 0.88-5.32) and 2.3 (95% CI, 0.94-5.81) times, respectively, when compared to athletes with hamstring injuries below these measurements. Conclusions: A larger size of hamstring injury was indicative of higher risk for recurrent injury but only after the subsequent playing season was considered along with the same playing season.None of the other parameters tested, including a shorter convalescent interval and clinical features, were associated with an increased risk for recurrent injury. However, due to low sample size the certainty of these conclusions may be limited. J Orthop Sports Phys Ther 2006;36(4):215-224.

Objective: To determine the effect of caesarean section on breast milk transfer (BMT) to the normal term infant over the first week of life. Method: A sample of 88 healthy nursing mothers who had a normal vaginal delivery, and 97 mothers who had a caesarean section were recruited from a teaching hospital. Mothers and midwives were instructed to weigh the infants before and after each feed throughout the study period using calibrated portable electronic scales. Results: The volume of milk transferred to infants born by caesarean section was significantly less than that transferred to infants born by normal vaginal delivery on days 2 to 5 (p < 0.05), but by day 6 there was no difference between the two groups (p = 0.08). The difference could not be explained by any of the maternal and infant variables measured. Birth weight was regained by day 6 in 40% of infants born vaginally compared with 20% in those born by caesarean section. Conclusion: There is a lag in the profile of the daily volume of breast milk transferred to infants delivered by caesarean section compared with those born by normal vaginal delivery. This study also challenges the widely followed schedules of milk volumes considered to be suitable for the term infant, which appear to be excessive, at least for the first four to five days post partum.T he effect of obstetric procedures on the transfer of breast milk from nursing mothers to their infants is not known. Anecdotal evidence suggests that variability in breast milk transfer (BMT) is dependent on the mode of delivery of the infant. BMT is a function of a finely tuned feedback mechanism, which is potentially susceptible to pharmacological, physical, and psychological manipulations of the mother and/or her infant.The effect of maternal opioids on newborn motor and respiratory behaviour is well documented. Nissen et al 1 have shown a delay in rooting and suckling behaviour in infants whose mothers received one modest dose of intramuscular pethidine in labour. These initial infant reflexes are considered pivotal in promoting BMT.The importance of maternal regional anaesthesia on the newborn's neurobehaviour is difficult to assess. There is no uniform neurobehavioural assessment tool, and changing anaesthetic protocols make it difficult to compare one study with another and relate them to continually evolving contemporary practice. Nevertheless, newborn effects have been reported. Scanlon et al, 2 using a combination of neurological tests, found that infants whose mothers received a continuous epidural block using lignocaine had lower motor scores, including rooting behaviour, than infants where a block was not used. This effect persisted for at least eight hours. However, the use of epidural bupivacaine did not appear to have the same effect in a later study by the same author. Study infants were similar to the non-medicated control group. Yet, using the neonatal behavioural assessment scale, Sepkoski et al 4 found that epidural bupivacaine did affect infant orientation and motor scores, even after...

Mass media interventions for preventing smoking in young people.

Community interventions for preventing smoking in young people.

No abstract