CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Comparative Study
Haemophilus influenzae meningitis in Manitoba and the Keewatin District, NWT: potential for mass vaccination.
A community-based surveillance study of all central nervous system infections was carried out in Manitoba and the Keewatin District, NWT, between Apr. 1, 1981, and Mar. 31, 1984. There were 201 cases of bacterial meningitis in Manitoba over the study period, 81 (40%) caused by Haemophilus influenzae; all but one isolate tested were type b (Hib). There were nine cases of H. influenzae meningitis in the Keewatin District. ⋯ The age at onset was earlier in native Indian children (22 cases) and Inuit children (9 cases) than in non-native children (59 cases) (p less than 0.005); thus, vaccine prevention of Hib meningitis will likely be more difficult in native Indian and Métis children. Without evaluating the increased potential of H. influenzae vaccines to prevent nonmeningitic forms of disease, we concluded that mass childhood vaccination with polyribosylribitolphosphate (PRP) vaccine is not warranted in Manitoba or the Keewatin District. Immunogenicity studies suggest that administration of conjugated Hib vaccines such as PRP-D in infancy may prevent approximately one-third to two-thirds of cases of H. influenzae meningitis; these vaccines warrant consideration for use in mass childhood vaccination programs.
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Comparative Study
Career and practice profiles of Alberta medical graduates (1973-85) practising in Alberta.
This collaborative study examined the career choices and practice locations of the 940 (58%) of the Alberta medical students graduating between 1973 and 1985 who remained in Alberta. Of the 686 practising graduates slightly less than two-thirds were in family/general practice; the remainder were in a specialty. More women (76%) than men (60%) had chosen family/general medicine. ⋯ Approximately 20% of the practising graduates chose to locate in small towns or rural areas. Accessibility to consultants and opportunities for continuing medical education were reported as vital prerequisites for more physicians to move to smaller Alberta centres. These findings provide a starting point for studies designed to determine how Alberta medical school graduates are contributing to patient care within the province.
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Review
Extrication, immobilization and radiologic investigation of patients with cervical spine injuries.
Most cervical spine injuries are due to motor vehicle accidents. Proper extrication of the victims is vital; the ideal device should be easily assembled and applied, should facilitate removal of victims from automobile seats without changing the body's position, must not hinder airway access or the performance of cardiopulmonary resuscitation, must accommodate all types of patients, including children and obese or pregnant patients, and must completely immobilize the patient, especially if hyperextension is suspected. Current methods of immobilization, such as the use of a soft collar and sandbags, allow neck extension; the short board protects against extension but interferes with airway access. ⋯ Radiologic examination of the first and second cervical vertebrae and the seventh cervical and first thoracic vertebrae should be emphasized. If lateral and anteroposterior views do not reveal abnormal findings and injury is still suspected, oblique views and computed or conventional tomography should be used. Cervical spinal cord injuries can be minimized or prevented if proper early management is applied.
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Students are introduced to techniques of physical examination at medical school. However, their skills are deficient at the time of graduation, and with the increasing shift of clinical teaching away from the bedside and into the conference room it is expected that these skills will weaken in succeeding generations of physicians. ⋯ We describe a program whose unique hierarchical approach has permitted a detailed ongoing review of physical examination. One clinician was able to teach 24 residents by instructing a small group of senior residents, who in turn, after practising with clinical clerks, taught groups of junior residents.