Application fever: Reviewing the causes, costs, and cures for residency application inflation

Over the past decade, the number of residency applications submitted per applicant has nearly doubled. This epidemic of Application Fever is expensive for applicants, burdensome for programs, and ultimately does not improve overall Match outcomes. In this review, we discuss the phenomenon of Application Fever, with a focus on contributing factors and costs of this behavior. Application Fever has its origins in the early 1990s. At that time, the number of residency applicants began to outpace the number of available positions. Because an applicant who applies to more residency programs has a greater probability of securing a residency position than an otherwise equivalent applicant who applies to fewer, overapplication became a dominant strategy and residency applicants began to apply to more residency programs each year. This trend was enhanced and enabled by the introduction of the Electronic Residency Application Service (ERAS). Although Application Fever is a rational decision for applicants, it imposes a substantial evaluative burden on program directors and necessitates the use of convenience screening metrics. We then briefly review potential solutions, including informational strategies, application limits, and marketplace incentives to reduce application numbers. Although a fixed cap on applications would reduce application numbers and facilitate a holistic selection process, greater transparency from residency programs regarding their selection criteria would be required to help applicants choose where to apply. To improve the residency application process for programs and applicants alike, we call upon the medical community to further study Application Fever and carefully consider solutions, including fixed application caps

Factors affecting the role of human resource department in private healthcare sector in Pakistan: a case study of Rehman Medical Institute (RMI)

The role of Human Resource Management in healthcare sector and challenges it faces has always been an important area of research both in developed and developing countries. The objective of this study is to evaluate the role of HR department in private healthcare sector in the province of Khyber Pakhtunkhwa (KPK), Pakistan and to analyze the challenges/factors affecting the role of HR department. Being the largest private sector hospital in KPK the researchers have selected RMI as a case for this study. Data was collected through interviews from different levels of employees in RMI. Constant comparative method was used for analyzing the data. Results present that HR department plays the role of an administrative expert in RMI. The major internal factors include workload, top management interference, management style and organizational culture which negatively effect motivation, performance and morale of the employees. While small labour market, undue interference of government and other higher authorities and trade unions are the external factors that affect the role of HR department in RMI. All these external factors create difficulties for HR department to attract and retain the desired workforce

The distribution of lead between sea salt dust, and lead-rich aerosols in the mid South Pacific easterlies at American Samoa

Aerosols in the South Pacific Easterlies have been sampled at American Samoa with a cascade impactor and analysed for Pb, Ba, K, Ca, Sr, and Rb by isotope dilution mass spectrometry using ultraclean procedures. Some 84% of the Pb was found in fine (≤ 0.5 μm) aerosols which were collected on the backup filter with an efficiency of only 33%. Sea salt and eroded terrestrial material (dust) containing 6% and <1% respectively, of the Pb (sea salt indexed by the metals K, Ca, Sr, and Rb and dust indexed by Ba) were collected on early stages of the impactor, although 65% of the dust, because of its larger size, was lost to surfaces of the rain shelter before reaching the impactor. The remaining 10% of the Pb was associated with plant leaf waxes of continental origin which produced Pb and Ba peaks on stage 4 (0.5 μ) of the impactor

Educating renal nurses - inferior vena caval ultrasound for intravascular volume assessment

Aim: Volume status of haemodialysis patients can be evaluated by trained doctors using ultrasound (US) of the inferior vena cava (IVC). To date, renal nurses have not been taught this skill. As part of a larger study exploring the use of US by renal nurses we developed an educational program to ensure that renal nurses received adequate US training to attain competence in IVC ultrasound (IVC-US). Methods: The educational program was divided into four parts. Initially a clinical US expert delivered the necessary theoretical and then practical components of the program. After this the nurse undertook a period of self-directed US practice (100 scans). During this period three formative reviews of the recorded scan clips with feedback occurred. Specific feedback covered US technique, image optimisation and acquisition and image interpretation. Finally, as a summative assessment the nurse performed and interpreted 60 scans on 10 dialysis patients. These scans were independently assessed for quality and the nurse interpretations reviewed for accuracy, prior to deeming the candidate competent to independently perform IVC-US. Findings: Ultrasound education involves knowledge and skill acquisition. Initial theoretical and practical education must be translated into competence through task repetition and targeted feedback. A staged educational program that involves these components is likely to be successful. The rate for US skill acquisition varies and a summative assessment ensuring competence prior to independent scanning is important. Conclusions: This four-step program demonstrated that it is feasible to educate a renal nurse in IVC-US for intravascular volume assessment

Cross-border hospital use: analysis using data linkage across four Australian states

Objective: To determine the quality and effectiveness of national data linkage capacity by performing a proof-of-concept project investigating cross-border hospital use and hospital-related deaths. Design, participants and setting: Analysis of person-level linked hospital separation and death registration data of all public and private hospital patients in New South Wales, Queensland and Western Australia and of public hospital patients in South Australia, totalling 7.7 million hospital patients from 1 July 2004 to 30 June 2009. Main outcome measures: Counts and proportions of hospital stays and patient movement patterns. Results: 223 262 patients (3.0%) travelled across a state border to attend hospitals, in particular, far northern and western NSW patients travelling to Queensland and SA hospitals, respectively. A further 48 575 patients (0.6%) moved their place of residence interstate between hospital visits, particularly to and from areas associated with major mining and tourism industries. Over 11 000 cross-border hospital transfers were also identified. Of patients who travelled across a state border to hospital, 2800 (1.3%) died in that hospital. An additional 496 deaths recorded in one jurisdiction occurred within 30 days of hospital separation from another jurisdiction. Conclusions: Access to person-level data linked across jurisdictions identified geographical hot spots of cross-border hospital use and hospitalrelated deaths in Australia. This has implications for planning of health service delivery and for longitudinal follow-up studies, particularly those involving mobile populations

Anthropogenic lead isotopes in Antarctica

We report the first measurements of Pb isotopes in Antarctic snow, which show that even recent snow containing 2.3 pg/g is highly polluted with anthropogenic Pb. This follows from a comparison of isotope abundances of Pb in surface snow and terrestrial dust extracted from ancient Antarctic ice (Dome C, depth 308 m, approximate age 7,500 a BP), the latter being distinctly more radiogenic. This result is independent of geochemical arguments based on measurements of Al, Na and SO_4. South America is suggested as a likely source of this anthropogenic Pb. The presence of significantly less radiogenic Pb in the snow adjacent to two Antarctic base stations indicates that there is contamination from station emissions, although emission from Australia is an alternative explanation for a site 33 km from Dumont d'Urville

Pemphigus foliaceus in a patient with gastrointestinal stromal tumor treated with adjuvant imatinib mesylate

Pemphigus is an autoimmune bullous disease with a number of described associations, including medications, which have been grouped into three structural categories - thiol drugs, phenol drugs, and drugs with neither functional group [1]. Discontinuation of the offending medication is considered a mainstay of therapy. We report a patient in whom the onset of pemphigus foliaceus was associated with initiation of imatinib mesylate adjuvant therapy in a patient with resected gastrointestinal stromal tumor (GIST). Imatinib was continued because of the survival benefit to the patient with a resected, high risk GIST. Treatment with rituximab resulted in near resolution of his blistering rash and follow up enzyme-linked immunosorbent assay (ELISA) demonstrated reference range immunoreactivity for both desmoglein 1 and desmoglein 3. After dose increase of imatinib therapy owing to tumor growth, the patient subsequently again developed a similar eruption. Re-biopsy and ELISA were consistent with recurrence of pemphigus. In conclusion, although the patient's pemphigus was cleared with a single cycle of rituximab infusions while continuing imatinib therapy, the disease returned after imatinib dose was increased a year later, suggesting a dose-response relationship

HPCSA Serious Injury Narrative Test guideline

Current South African Road Accident Fund (RAF) legislation requires a medical determination of the seriousness of injuries sustained in motor vehicle accidents to determine whether the claimant is entitled to a claim for general damages. Such medical assessments are submitted in the form of RAF 4 Serious Injury Assessment Reports. Contested claims for serious injury are referred to the Health Professions Council of South Africa (HPCSA) Appeal Tribunals for final determination. The legislation prescribes 2 instruments, namely the American Medical Association (AMA) Guides (6th edition) and the Narrative Test for this purpose. Whereas the AMA Guides are published in a comprehensive book, and training courses are provided in their use, existing legislation does not provide any indication of the required structure, content or criteria of a Narrative Test report. This document is published by the HPCSA Appeal Tribunals as a guideline to the performance of the Narrative Test; what it is, reasons for applying it and who should compile it, as well as the required structure, content and criteria thereof. A Narrative Test Report should include relevant and meaningful comment in relation to each of the 6 sections described in the article.