The results suggest that medical students are interested in learning about alternative medical therapies and they perceive this knowledge will be important to them as physicians. As medical schools undertake various curriculum reforms they should be aware of rising student interest in alternative medical therapies.
This essay begins with the history from 1989 through late 1991 of the Primary Care Organization's Consortium (PCOC), a group of representatives from nine major academic and professional organizations for primary care specialties. The PCOC was formed to discuss what might be done to reverse the alarming decrease in the number of medical students who choose primary care specialties. The article reviews some of the conditions that many believe have caused the continuing move away from primary care careers, and concludes with a description of the PCOC's program to encourage medical students to choose primary care careers, and the new opportunities for collaborative planning of such programs that are now available to medical schools. The PCOC's success in defining its program is due to a process of interdisciplinary planning and collaboration at the national level that hopefully will facilitate similar collaboration among medical school departments.
Introduction Pain management in patients with hip fractures can be challenging. Poor pain control is associated with reduced mobility and increased morbidity. Inadequate analgesia in patients with dementia is a concern. After using several different alternatives, transdermal buprenorphine was chosen as a standardised approach for analgesia in patients with fragility fracture in our hospital. There is limited evidence on the use of buprenorphine in this population. Our aim was to investigate the safety and effectiveness of transdermal buprenorphine in patients with hip fractures. Methods A review of consecutive patients presenting with a hip fracture from June 2018 to December 2018 was conducted using medical records. Our primary outcome was the incidence of complications as a consequence of transdermal buprenorphine. Our secondary outcome was adequate analgesia measured by reviewing the requirement for analgesia during the first week following the patient’s admission. Analgesia demands were considered adequate if patients required less than 20 mg of oral morphine in total during the first week following injury. Results In total, 148 patients presented with a hip fracture during the study period. 128 patients had documented evidence of buprenorphine patch application. Complete data was available for the primary outcome of complications in all cases. Data was available for the secondary outcome in 124 patients. Buprenorphine was discontinued in 24 patients (19%), most commonly due to due to concerns about contribution to hypoactive delirium (9%), and when strong analgesia was no longer required (4%). There were no severe complications. Adequate analgesia was achieved using this regime in 68% patients. 38 patients (32%) required more than 20 mg of oral morphine sulphate solution in the first week post-admission. Conclusion This series suggests that transdermal buprenorphine is safe and effective in the management of pain following a neck of femur fragility fracture.
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