Systematic review of new medics’ clinical task experience by country

OBJECTIVES: There is a need for research which informs on the overall size and significance of clinical skills deficits among new medics, globally. There is also the need for a meta-review of the similarities and differences between countries in the clinical skills deficits of new medics. DESIGN: A systematic review of published literature produced 68 articles from Google/Scholar, of which 9 met the inclusion criteria (quantitative clinical skills data about new medical doctors). PARTICIPANTS: 1329 new medical doctors (e.g., foundation year-1s, interns, PGY1s). SETTING: Ten countries/regions. MAIN OUTCOME MEASURES: 123 data points and representation of a broad range of clinical procedures. RESULTS: The average rate of inexperience with a wide range of clinical procedures was 35.92% (lower CI 30.84%, upper CI 40.99%). The preliminary meta-analysis showed that the overall deficit in experience is significantly different from 0 in all countries. Focusing on a smaller selection of clinical skills such as catheterisation, IV cannulation, nasogastric tubing and venepuncture, the average rate of inexperience was 26.75% (lower CI 18.55%, upper CI 35.54%) and also significant. England presented the lowest average deficit (9.15%), followed by New Zealand (18.33%), then South Africa (19.53%), Egypt, Kuwait, Gulf Cooperation Council countries and Ireland (21.07%), after which was Nigeria (37.99%), then USA (38.5%), and Iran (44.75%). CONCLUSION: A meta-analysis is needed to include data not yet in the public domain from more countries. These results provide some support for the UK General Medical Council’s clear, detailed curriculum, which has been heralded by other countries as good practice

Prasugrel results in higher decrease in high-sensitivity C-reactive protein level in patients undergoing percutaneous coronary intervention comparing to clopidogrel

Objectives: A growing body of clinical and laboratory evidence indicates that inflammation plays a crucial role in atherosclerosis. In the present study, we compared the effects of clopidogrel and prasugrel on high-sensitivity C-reactive protein (hs-CRP) in patients undergoing percutaneous coronary intervention (PCI). Methods: The present randomized, double-blind clinical trial included 120 patients who underwent PCI. Eligible patients were randomly assigned 2:1 to one of the two groups: 80 patients in the first group received clopidogrel (Plavix®; loading dose and maintenance dose of 300 and 75 mg daily, respec-tively) and 40 patients in the second group received prasugrel (Effient®; loading dose and maintenance dose of 60 and 10 mg, respectively) for 12 weeks. The hs-CRP levels between baseline and 12th week were compared.Results: Of the 120 patients, 69 patients (57.5) were male. Pretreatment hs-CRP level was statistically comparable in clopidogrel (median, 15.10 mg/dL; interquartile range IQR, 9.62-23.75 mg/dL) and prasugrel groups (median, 18 mg/dL; IQR, 14.25-22 mg/dL; P = 0.06). Patients taking clopidogrel showed a significant reduction in hs-CRP level compared with the baseline values (P < 0.001). Prasugrel administration also resulted in a significant reduc-tion in hs-CRP level (P < 0.001). A significant 73% overall reduction in the hs-CRP level was seen with prasugrel compared with 39% overall reduction in hs-CRP level with clopidogrel (P = 0.002). Conclusion: Prasugrel seems to be superior to clopidogrel in the reduction of hs-CRP in patients undergoing PCI. © the authors, publisher and licensee Libertas Academica Limited

Seroprevalence of Pandemic (H1N1) 2009 in Pregnant Women in China: An Observational Study

BACKGROUND: We investigated the seropositive rates and persistence of antibody against pandemic (H1N1) 2009 virus (pH1N1) in pregnant women and voluntary blood donors after the second wave of the pandemic in Nanjing, China. METHODOLOGY/PRINCIPAL FINDINGS: Serum samples of unvaccinated pregnant women (n = 720) and voluntary blood donors (n = 320) were collected after the second wave of 2009 pandemic in Nanjing. All samples were tested against pH1N1 strain (A/California/7/2009) with hemagglutination inhibition assay. A significant decline in seropositive rates, from above 50% to about 20%, was observed in pregnant women and voluntary blood donors fifteen weeks after the second wave of the pandemic. A quarter of the samples were tested against a seasonal H1N1 strain (A/Brisbane/59/2007). The antibody titers against pH1N1 strain were found to correlate positively with those against seasonal H1N1 strain. The correlation was modest but statistically significant. CONCLUSIONS AND SIGNIFICANCE: The high seropositive rates in both pregnant women and voluntary blood donors suggested that the pH1N1 virus had widely spread in these two populations. Immunity derived from natural infection seemed not to be persistent well

The Age-Specific Cumulative Incidence of Infection with Pandemic Influenza H1N1 2009 Was Similar in Various Countries Prior to Vaccination

Background: During the influenza pandemic of 2009 estimates of symptomatic and asymptomatic infection were needed to guide vaccination policies and inform other control measures. Serological studies are the most reliable way to measure influenza infection independent of symptoms. We reviewed all published serological studies that estimated the cumulative incidence of infection with pandemic influenza H1N1 2009 prior to the initiation of population-based vaccination against the pandemic strain. Methodology and Principal Findings: We searched for studies that estimated the cumulative incidence of pandemic influenza infection in the wider community. We excluded studies that did not include both pre- and post-pandemic serological sampling and studies that included response to vaccination. We identified 47 potentially eligible studies and included 12 of them in the review. Where there had been a significant first wave, the cumulative incidence of pandemic influenza infection was reported in the range 16%-28% in pre-school aged children, 34%-43% in school aged children and 12%-15% in young adults. Only 2%-3% of older adults were infected. The proportion of the entire population infected ranged from 11%-18%. We re-estimated the cumulative incidence to account for the small proportion of infections that may not have been detected by serology, and performed direct age-standardisation to the study population. For those countries where it could be calculated, this suggested a population cumulative incidence in the range 11%-21%. Conclusions and Significance: Around the world, the cumulative incidence of infection (which is higher than the cumulative incidence of clinical disease) was below that anticipated prior to the pandemic. Serological studies need to be routine in order to be sufficiently timely to provide support for decisions about vaccination. © 2011 Kelly et al.published_or_final_versio

Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09‐related pneumonia: an individual participant data meta‐analysis

BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. METHODS: A worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support

<i>Fasciola hepatica</i>: A cause of obstructive Jaundice in an elderly man from Iran

Fascioliasis is a zoonotic infection caused by Fasciola hepatica . Humans can become accidental hosts of this parasite by ingesting contaminated drinking water or plants in endemic area. The north of Iran is one of the regions. This disease is rarely seen with jaundice caused by obstruction of the biliary tree. We report a case of human fascioliasis with obstructive jaundice who was diagnosed using endoscopic retrograde cholangiopancreatography (ERCP). This report confirms the diagnostic role of ERCP in patients with obstructive jaundice caused by biliary fascioliasis