Some students struggle through medical school and do not have the confidence to seek help. This pilot study sought to explore the challenges and needs of medical students experiencing academic difficulty. Semi-structured interviews and online surveys were used to collect data from an academic advisor and thirteen medical students who had experienced academic difficulty. Unexpected academic failure and the loss of self-efficacy contributed to students hiding their academic difficulty and avoiding available support systems. Despite the sampling limitations, the findings of this pilot study have value in giving direction to future research. Programs that will change the current attitudes to academic difficulty, normalising access to support and encouraging early intervention, are needed to build the capacity for excellence among these students.

Following publication of the original article [1], one of the authors reported that prior to publication her surname had changed from 'Kerlen' to 'van der Kruk', but that this change had not been incorporated in the final version.

This paper presents findings from the rural and remote road safety study, conducted in Queensland, Australia, from March 2004 till June 2007, and compares fatal crashes and non-fatal but serious crashes in respect of their environmental, vehicle and operator factors. During the study period there were 613 non-fatal crashes resulting in 684 hospitalised casualties and 119 fatal crashes resulting in 130 fatalities. Additional information from police sources was available on 103 fatal and 309 non-fatal serious crashes. Over three quarters of both fatal and hospitalised casualties were male and the median age in both groups was 34 years. Fatal crashes were more likely to involve speed, alcohol and violations of road rules and fatal crash victims were 2½ times more likely to be unrestrained inside the vehicle than non-fatal casualties, consistent with current international evidence. After controlling for human factors, vehicle and road conditions made a minimal contribution to the seriousness of the crash outcome. Targeted interventions to prevent fatalities on rural and remote roads should focus on reducing speed and drink driving and promoting seatbelt wearing.

OBJECTIVE:To define characteristics of vehicle crashes occurring on rural private property in north Queensland with an exploration of associated risk factors.DESIGN:Descriptive analysis of private property crash data collected by the Rural and Remote Road Safety Study.SETTING:Rural and remote north Queensland.PARTICIPANTS:A total of 305 vehicle controllers aged 16 years or over hospitalised at Atherton, Cairns, Mount Isa or Townsville for at least 24 hours as a result of a vehicle crash.MAIN OUTCOME MEASURE:A structured questionnaire completed by participants covering crash details, lifestyle and demographic characteristics, driving history, medical history, alcohol and drug use and attitudes to road use.RESULTS:Overall, 27.9% of interviewees crashed on private property, with the highest proportion of private road crashes occurring in the North West Statistical Division (45%). Risk factors shown to be associated with private property crashes included male sex, riding off-road motorcycle or all-terrain vehicle, first-time driving at that site, lack of licence for vehicle type, recreational use and not wearing a helmet or seatbelt.CONCLUSIONS:Considerable trauma results from vehicle crashes on rural private property. These crashes are not included in most crash data sets, which are limited to public road crashes. Legislation and regulations applicable to private property vehicle use are largely focused on workplace health and safety, yet work-related crashes represent a minority of private property crashes in north Queensland.

OBJECTIVE:To define characteristics of all-terrain vehicle (ATV) crashes occurring in north Queensland from March 2004 till June 2007 with the exploration of associated risk factors.DESIGN:Descriptive analysis of ATV crash data collected by the Rural and Remote Road Safety Study.SETTING:Rural and remote north Queensland.PARTICIPANTS:Forty-two ATV drivers and passengers aged 16 years or over hospitalised at Atherton, Cairns, Mount Isa or Townsville for at least 24 hours as a result of a vehicle crash.MAIN OUTCOME MEASURES:Demographics of participants, reason for travel, nature of crash, injuries sustained and risk factors associated with ATV crash.RESULTS:The majority of casualties were men aged 16-64. Forty-one per cent of accidents occurred while performing agricultural tasks. Furthermore, 39% of casualties had less than one year's experience riding ATVs. Over half the casualties were not wearing a helmet at the time of the crash. Common injuries were head and neck and upper limb injuries. Rollovers tended to occur while performing agricultural tasks and most commonly resulted in multiple injuries.CONCLUSIONS:Considerable trauma results from ATV crashes in rural and remote north Queensland. These crashes are not included in most general vehicle crash data sets, as they are usually limited to events occurring on public roads. Minimal legislation and regulation currently applies to ATV use in agricultural, recreational and commercial settings. Legislation on safer design of ATVs and mandatory courses for riders is an essential part of addressing the burden of ATV crashes on rural and remote communities.

Objective: To assess the suitability of Queensland's graduated licensing system in the context of rural and remote Queensland. Design: Age-based comparison of crash data collected by the Rural and Remote Road Safety Study (RRRSS). Setting: Rural and remote North Queensland. Participants: A total of 367 vehicle controllers aged 16 years or over hospitalised at Townsville, Cairns or Mount Isa for at least 24 hours, or killed, as a result of a vehicle crash. Measurements: Specific RRRSS variables are assessed in relation to Queensland's graduated licensing program, including rates of unlicensed driving/riding, late night crashes, crashes with multiple passengers, contributing factors in crashes and vehicle types involved. Results: While people between 16 and 24 years of age comprise 16% of the target population, 25% of crashes meeting RRRSS criteria involved a vehicle controller in that age group. 12.8% of all cases involved an unlicensed driver/rider, within which 66% were below 25 years of age. Young drivers/riders were represented in 50% of crashes occurring between 11:00 p.m. and 5:00 a.m., and 33% of crashes in vehicles with multiple passengers. Motorcyclists represented about 40% of cases in both age groups. There were no significant differences between age groups in vehicle types used, or circumstances that contributed to crashes. Conclusions: The general overrepresentation of young drivers/riders in rural and remote North Queensland supports tailored interventions, such as graduated licensing. However, while some measures in the legislation are well supported, problems surrounding unlicensed driving/riding might be exacerbated.

Objective: To assess the suitability of Queensland's graduated licensing system in the context of rural and remote Queensland. Design: Age-based comparison of crash data collected by the Rural and Remote Road Safety Study (RRRSS). Setting: Rural and remote North Queensland. Participants: A total of 367 vehicle controllers aged 16 years or over hospitalised at Townsville, Cairns or Mount Isa for at least 24 hours, or killed, as a result of a vehicle crash. Measurements: Specific RRRSS variables are assessed in relation to Queensland's graduated licensing program, including rates of unlicensed driving/riding, late night crashes, crashes with multiple passengers, contributing factors in crashes and vehicle types involved. Results: While people between 16 and 24 years of age comprise 16% of the target population, 25% of crashes meeting RRRSS criteria involved a vehicle controller in that age group. 12.8% of all cases involved an unlicensed driver/rider, within which 66% were below 25 years of age. Young drivers/riders were represented in 50% of crashes occurring between 11:00 p.m. and 5:00 a.m., and 33% of crashes in vehicles with multiple passengers. Motorcyclists represented about 40% of cases in both age groups. There were no significant differences between age groups in vehicle types used, or circumstances that contributed to crashes. Conclusions: The general overrepresentation of young drivers/riders in rural and remote North Queensland supports tailored interventions, such as graduated licensing. However, while some measures in the legislation are well supported, problems surrounding unlicensed driving/riding might be exacerbated.

The purpose of this paper was to demonstrate that the medical workforce shortage is an international phenomenon and to review one of the strategies developed in the USA in the late 1960s: the physician assistant model of health service provision. The authors consider whether this model could provide one strategy to help address the medical workforce shortage in Australia. A systematic review of the literature about medical workforce shortages, strategies used to address the medical workforce shortage, and the physician assistant role was undertaken. Literature used for the review covered the period 1967-2006. Physician assistants provide safe, high-quality and cost-effective primary care services under the direction of a doctor and respond to workforce shortages in rural and remote areas, family practice medicine and hospital settings. This model of health care provision has been adopted in several other developed countries, including England, Scotland, the Netherlands and Canada. The physician assistant concept might provide Australia with a novel strategy for addressing its medical workforce shortage, particularly in rural and remote settings.

Deaths from rural road crashes continue at a higher rate per head of population than that for major cities, with the risk of dying on rural roads exceeding that on motorways by four to six times. In response to such evidence and the paucity of research specifically examining rural road trauma, a five-year multi-component study aimed at increasing knowledge about rural and remote road crashes and informing road safety policy was designed. This paper presents some initial results from two components of the study: interviews with road crash patients admitted to hospital between March 2004 and May 31 2006; and interviews with road users passing the sites where the hospital interviewees’ crashes occurred 1-2 weeks previously. Demographic data, use of safety restraints and helmets, levels of drinking and attitudes to road safety practices and enforcement are reported.

In rural and remote Australia, per capita risk of death or injury from a vehicle crash is substantially higher than that for urban areas. Historically this has always been so, and a paucity of prior research in this area inspired the Rural and Remote Road Safety Study, goals of which include assessing and developing interventions to reduce the incidence and associated costs of crashes outside cities. With three years of rural and remote crash data collection completed, findings indicate driver behaviour contributes to most crashes, and is the sole cause in a large proportion of these. Over 380 patients admitted to a major North Queensland hospital for at least 24 hours following a vehicle crash consented to an interview in which a structured questionnaire was administered. This paper reports on responses to questions regarding seatbelt and helmet use, speeding, alcohol consumption and self-reported drink driving. We also analyse desired changes in enforcement of road laws, and perceived effectiveness of specific interventions. Seeking to further identify potential links between behaviour, attitude and crash involvement, the study compares responses of hospitalised patients with those of other road users in specific crash vicinities. Results suggest that rural road users hospitalised after a crash are more likely to binge-drink, drink drive and disregard road rules, and are less likely to wear seatbelts than those not involved in crashes. Development of more effective interventions targeting attitude and behaviour is essential if crashes and their impacts are to be significantly reduced in rural and remote Australia.

Sixteen patients (aged 59 +/- 14 years) undergoing coronary artery bypass surgery were evaluated to delineate the intraoperative course of transesophageal echocardiographic right ventricular (RV) systolic performance indices. Pre-induction data included thermodilution RV ejection fraction (RVEFTD), 0.43 +/- 0.13, RV end-diastolic volume index (EDVI), 110 +/- 33 mL/m2, cardiac index (CI), 3.4 +/- 1.0 L/min/m2, RV end-diastolic pressure (EDP), 7.1 +/- 4.2 mmHg, and mean pulmonary artery pressure (PAP), 21 +/- 6 mmHg. Eleven patients had significant right coronary artery (RCA) disease (> 70% occlusion). Five patients arrived with an ongoing nitroglycerin infusion (1 to 3 micrograms/kg/min), which was maintained intraoperatively. Echocardiographic measurements included longitudinal-axis (LA) and short-axis (SA) planimetered area excursion fractions (2DLA and 2DSA, respectively) and LA maximal major and minor axis shortening fractions (max majorLA and max minorLA, respectively). Hemodynamic measurements included RVEFTD, EDVI, CI, EDP, and PAP. Measurements were determined following induction/endotracheal intubation, following sternotomy/pericardiotomy, and after cardiopulmonary bypass (CPB) with the chest open. All patients were maintained on vasodilator therapy post-CPB (nitroglycerin, 1 to 3 micrograms/kg/min [N = 16] and nitroprusside, 0.5 to 4.5 microgram/kg/min [N = 4]) post-CPB. Two patients received inotropic support (epinephrine, 0.2 to 0.3 microgram/kg/min). CPB was associated with significant decreases in max major axisLA and 2DLA (P < 0.05) as compared to measurements determined prior to CPB. Maximum major axisLA values pre-CPB were 0.35 +/- 0.06 and 0.33 +/- 0.08 versus post-CPB values of 0.24 +/- 0.08.(ABSTRACT TRUNCATED AT 250 WORDS)

Intensive treatment of insulin-dependent diabetes mellitus during pregnancy often normalizes plasma glucose levels. However, it is unclear whether this adversely affects other metabolic fuels that are essential to normal fetal growth and development. Metabolic studies were conducted after the subjects ingested a standardized mixed meal during each trimester in 7 normal and 15 insulin-dependent diabetic pregnant women. The latter were treated with continuous subcutaneous insulin infusion or multiple injections, which were adjusted to achieve strict glucose control throughout pregnancy. Insulin, alanine, branched-chain amino acids, triglycerides, free fatty acids, and ketones were measured every 15 to 30 minutes before a standardized breakfast and for 150 minutes after the breakfast. Patients with insulin-dependent diabetes mellitus were studied while they received their unusual insulin dosages. Fasting glucose levels (87 +/- 7 mg/dl) and glucose levels 150 minutes after the meal (112 +/- 11 mg/dl) were near normal. However, normoglycemia was achieved at the expense of increased plasma insulin levels (area under insulin response curves, p less than 0.01, vs nondiabetic curves). Nevertheless, fasting and post-prandial plasma branched-chain amino acids, alanine, and free fatty acids were similar in both groups. Fasting cholesterol, triglyceride, and ketone levels were also normalized. We conclude that normalization of circulating amino acids and lipids in conjunction with correction of hyperglycemia may contribute to favorable outcomes in infants of intensively treated diabetic mothers.

The oral glucose tolerance test is the recommended method for the assessment of carbohydrate metabolism in pregnancy. However, available glucose drinks are often associated with varying degrees of gastrointestinal symptoms that might preclude meaningful studies. Polycose (Ross Labs, Columbus, Ohio) is a glucose saccharide polymer mixture containing 3% glucose, 7% maltose, 5% maltotriose, and 85% polysaccharide of 4 to 15 glucose units, with an osmotic load one fifth that of glucose. We assessed the efficacy of this glucose polymer in the performance of a 3-hour carbohydrate tolerance test with glucose and glucose polymer used 3 to 5 days apart in each patient tested. After 2 days of 300 gm carbohydrate-enriched diets, 48 patients underwent 3-hour carbohydrate tolerance tests at a mean gestational age of 30 +/- 3 weeks. Statistical analysis revealed a moderate level of agreement (kappa = 0.45, p less than 0.001) between the results of both carbohydrate tolerance test preparations. Patients experienced fewer gastrointestinal symptoms with the glucose polymer than with glucose. These preliminary data suggest that glucose polymer may be effectively used in the performance of a 3-hour carbohydrate tolerance test.

Welcome to nursing in the tropics. The purpose of this chapter is to discuss some of the issues specifically associated with nursing in the tropics. You will have your own definition of nursing and there is no intention to define nursing here, though Henderson's definition is considered later in the paper. The term 'tropics' refers to a large part of the planet and there are many different places in which to use nursing skills. You would be working in the tropics if you took a job at Darwin Hospital. You would also be working in the tropics if you were working in the Solomon Islands, on indigenous communities in northern Australia, at a refugee camp in Uganda, or in a modern clinic in the United Arab Emirates. If you look at a map of the world you can see that the tropics covers most of Africa, South East Asia, most of the islands of the Pacific, northern Australia, a large part of South America and the Caribbean area. Within this region we find deserts, tropical forests, large cities, small remote communities, heat, cyclones, teeming rain and drought. Some inhabitants are extremely poor while others are among the richest ten percent of the world. Civil war continues in some tropical countries and refugees flee for safety causing great strain on the countries to which they flee. Chapter 1 deals with the tropical environment in some detail. If we take the terms literally nursing in the tropics could range from working in a crowded refugee camp in Central Africa to working in a modern well-equipped major hospital in northern Australia. Just as there are many parts of the tropics in which you may be working, there are many different nursing contexts in these areas. You could be working for one of the health departments of the northern Australian states with your work based in city hospitals or city based health services, rural hospitals or remote area nursing posts where you are working alone. You could be working with Medicins Sans Frontiers in a refugee camp, or the Australian peacekeepers in a range of locations. You may be working for the tourist industry on an island resort in North Queensland or assisting in the development of a malaria program in a poorly resourced Pacific nation. With so many potential working environments it is not possible to write in detail about each one of them. Rather topics will be covered in general terms and from this you will be able to apply the information to your specific area of work. This chapter will not be considering nursing in well-equipped hospitals or clinics. However what will be covered are some of the key issues related to working in contexts that are challenging to us, and ways of preparing ourselves for these contexts. Specific topics that will be addressed include working with reduced physical and human resources particularly in rural and remote locations, the issues associated with extension of nursing practice and dealing with unfamiliar clinical situations, cultural differences that may be encountered and personal challenges we may face when moving to a different locality.