Report on 7 Years' Experience Implementing an Undergraduate Medical Curriculum for Osteopathic Medical Students Using Entrustable Professional Activities.

Calls for changes in undergraduate medical education and the advent of the single graduate medical education accreditation system have challenged the osteopathic medical profession to maintain its identity and distinctiveness while adapting to innovations. For the osteopathic medical profession to thrive, its colleges must provide students with an educational framework that solidifies their osteopathic identity. The authors developed an integrated anatomy-clinical skills course at the University of New England College of Osteopathic Medicine, Osteopathic Clinical Skills, that used the performance benchmarks of the Entrustable Professional Activities and the Osteopathic Core Competencies for Medical Students from the American Association of Colleges of Osteopathic Medicine.

Initiating an undiagnosed diseases program in the Western Australian public health system.

Background: New approaches are required to address the needs of complex undiagnosed diseases patients. These approaches include clinical genomic diagnostic pipelines, utilizing intra- and multi-disciplinary platforms, as well as specialty-specific genomic clinics. Both are advancing diagnostic rates.

National Sleep Foundation's sleep quality recommendations: first report.

Objectives: To provide evidence-based recommendations and guidance to the public regarding indicators of good sleep quality across the life-span.

Methods: The National Sleep Foundation assembled a panel of experts from the sleep community and representatives appointed by stakeholder organizations (Sleep Quality Consensus Panel). A systematic literature review identified 277 studies meeting inclusion criteria.

Dorsal Scapular Artery Variations and Relationship to the Brachial Plexus, and a Related Thoracic Outlet Syndrome Case.

 Knowledge of the relationship of the dorsal scapular artery (DSA) with the brachial plexus is limited.  We report a case of a variant DSA path, and revisit DSA origins and under-investigated relationship with the plexus in cadavers.  The DSA was examined in a male patient and 106 cadavers.

Do we need medical leadership or medical engagement?

Purpose: The purpose of this paper is to address issues of medical leadership within health systems and to clarify the associated conceptual issues, for example, leadership versus management and medical versus clinical leadership. However, its principle contribution is to raise the issue of the purpose or outcome of medical leadership, and, in this respect, it argues that it is to promote medical engagement.

Design/methodology/approach: The approach is to provide evidence, both from the literature and empirically, to suggest that enhanced medical engagement leads to improved organisational performance and, in doing so, to review the associated concepts.

Posterior approach to kidney dissection: An old surgical approach for integrated medical curricula.

Integrated medical curricular changes are altering the historical regional anatomy approach to abdominal dissection. The renal system is linked physiologically and biochemically to the cardiovascular and respiratory systems; yet, anatomists often approach the urinary system as part of the abdomen and pelvic regions. As part of an integrated curriculum, the renal system must be covered relatively quickly after the thorax in the cadaver laboratory, often without the opportunity to fully appreciate the rest of the abdominal contents.

Increased hospital costs associated with red blood cell transfusion.

Background: Red blood cell (RBC) transfusion is independently associated in a dose-dependent manner with increased intensive care unit stay, total hospital length of stay, and hospital-acquired complications. Since little is known of the cost of these transfusion-associated adverse outcomes our aim was to determine the total hospital cost associated with RBC transfusion and to assess any dose-dependent relationship.

Study Design And Methods: A retrospective cohort study of all multiday acute care inpatients discharged from a five hospital health service in Western Australia between July 2011 and June 2012 was conducted.

Measuring the incidence of hospital-acquired complications and their effect on length of stay using CHADx.

Objectives: To use an automated Classification of Hospital Acquired Diagnoses (CHADx) reporting system to report the incidence of hospital-acquired complications in inpatients and investigate the association between hospital-acquired complications and hospital length of stay (LOS) in multiday-stay patients.

Design: Retrospective cross-sectional study for calendar years 2010 and 2011.

Setting: South Metropolitan Health Service in Western Australia, which consists of two teaching and three non-teaching hospitals.

Correlation of paired toxic plasma and saliva paracetamol concentrations following deliberate self-poisoning with paracetamol.

What Is Already Known About This Subject: • Paracetamol is commonly used in deliberate self poisoning (DSP) and this requires blood sampling to refine risk assessment. If saliva concentrations agreed with plasma concentrations, then this could support the development of non-invasive testing. Our pilot work supports this hypothesis, but was largely confined to nontoxic concentrations.

Patient perceptions of the potential lethality associated with deliberate self-poisoning.

Introduction: Little is known about patient perceptions of the lethality of their overdose. Our aim was to compare patient perceptions with the risk assessment of clinical toxicologists.

Methods: A prospective observational study of overdose patients presenting to a tertiary hospital.

Brain abnormalities detected on magnetic resonance imaging of amphetamine users presenting to an emergency department: a pilot study.

Objectives: To determine the prevalence of occult brain abnormalities in magnetic resonance imaging of active amphetamine users.

Design, Setting And Participants: Prospective convenience study in a tertiary hospital emergency department (ED). Patients presenting to the ED for an amphetamine-related reason were eligible for inclusion.

Morbidity associated with heroin overdose presentations to an emergency department: a 10-year record linkage study.

Introduction: To examine hospitalizations in a cohort of 224 patients who presented with non-fatal heroin overdose to an ED.

Methods: A record linkage study, using the morbidity, mental health and mortality databases in the Data Linkage Unit of the Department of Health, Western Australia. The main outcome measures were hospital separations 5 years before and after entry into the cohort.

Use of electronic anatomy practical examinations for remediating "at risk" students.

Restrictive laboratory scheduling, an increasing number of human cadaver-based anatomy courses and a reduction in the curricular time allotted to anatomy courses have created problems with cadaver laboratory access at the University of New England. This article describes a combination of anatomy testing and grading strategies to allow "at risk" (borderline failing) students an opportunity to remediate their lowest set of examination scores and pass their anatomy course. An alternative electronic practical examination for these students provided flexibility in laboratory scheduling, thereby increasing laboratory access for other students taking concurrent courses.

Overuse of non-prescription analgesics by dental clinic patients.

Background: Many patients present to dental clinics for treatment of painful conditions. Prior to seeking treatment, many of these patients will self-medicate with non-prescription analgesics (NPA), and some will unintentionally overdose on these products. The objective of this study is to describe the use of NPA among dental patients.

Guidelines for the management of paracetamol poisoning in Australia and New Zealand--explanation and elaboration. A consensus statement from clinical toxicologists consulting to the Australasian poisons information centres.

Paracetamol is involved in a large proportion of accidental paediatric exposures and deliberate self-poisoning cases, although subsequent hepatic failure and death are both uncommon outcomes. The optimal management of most patients with paracetamol overdose is usually straightforward. However, several differing nomograms and varying recommendations regarding potential risk factors for hepatic injury introduce complexity.

Deliberate self-poisoning with tiagabine: an unusual toxidrome.

Tiagabine is an anticonvulsant acting by selective inhibition of neuronal and glial gamma-aminobutyric acid uptake, resulting in increased gamma-aminobutyric acid-mediated inhibition in the brain. Few reports in the literature describe the clinical course of severe tiagabine intoxication. A 44-year-old woman presented after deliberate self-poisoning with 100 tiagabine 15 mg tablets (1,500 mg; 25 mg/kg).

Amphetamine-related presentations to an inner-city tertiary emergency department: a prospective evaluation.

Objective: To describe the prevalence, characteristics and outcomes of amphetamine-related presentations to a tertiary hospital emergency department (ED).

Design, Setting And Participants: Prospective observational study of amphetamine-related presentations to the ED of the Royal Perth Hospital (RPH), an adult, inner-city, tertiary referral hospital, between 3 August and 2 November 2005. For all patients presenting to the ED, the treating doctors were automatically prompted by the computerised data entry system to consider amphetamine use.

Amisulpride deliberate self-poisoning causing severe cardiac toxicity including QT prolongation and torsades de pointes.

Although clinical trials of the antipsychotic amisulpride revealed no cardiac adverse effects, four patients with severe cardiac toxicity after overdose were reported to Australian poisons information centres in 2004-2005. All four had QT prolongation over 500 ms, two had rate-dependent bundle branch block, two developed torsades de pointes, and one died after cardiac arrest. Pending further studies, we recommend electrocardiogram assessment until at least 16 h after amisulpride overdose and, if QT interval is prolonged, cardiac monitoring until the patient is clinically well and conduction intervals are normal.

Antivenom dosing in 35 patients with severe brown snake (Pseudonaja) envenoming in Western Australia over 10 years.

Objective: To investigate the doses of antivenom administered to adult patients with severe brown snake envenoming.

Design And Setting: Review of charts from Western Australian adult teaching hospitals, December 1991 to December 2001.

Patients: 35 patients with severe brown snake envenoming, defined prospectively as afibrinogenaemia (< 0.

Prospective evaluation of repeated supratherapeutic acetaminophen (paracetamol) ingestion.

Study Objective: Repeated supratherapeutic ingestion of acetaminophen is potentially lethal but poorly described. We provide the first prospective description of the characteristics, course, and outcome of patients with repeated supratherapeutic ingestion of acetaminophen.

Methods: This was a prospective case series of consecutive patients aged 12 years and older with acetaminophen dosage greater than 4 g per 24 hours referred to our poison center.