Building a sustainable clinical academic workforce to meet the future healthcare needs of Australia and New Zealand: report from the first summit meeting

The delivery of healthcare that meets the requirements for quality, safety and cost-effectiveness relies on a well-trained medical workforce, including clinical academics whose career includes a specific commitment to research, education and/or leadership. In 2011, the Medical Deans of Australia and New Zealand published a review on the clinical academic workforce and recommended the development of an integrated training pathway for clinical academics. A bi-national Summit on Clinical Academic Training was recently convened to bring together all relevant stakeholders to determine how best to do this. An important part understood the lessons learnt from the UK experience after 10 years since the introduction of an integrated training pathway. The outcome of the summit was to endorse strongly the recommendations of the medical deans. A steering committee has been established to identify further stakeholders, solicit more information from stakeholder organisations, convene a follow-up summit meeting in late 2015, recruit pilot host institutions and engage the government and future funders.

Age and diet effects on relative renal echogenicity in geriatric bitches

Under controlled, but varied dietary conditions 35 geriatric, uninephrectomized, spayed Beagle bitches (dogs) observed for 4 years, renal cortical and renal medullary echogenicity was measured relative to hepatic and splenic echogenicity. Regardless of the diet fed, 60-75% of these aged dogs had renal cortical echogenicity less than that of either the liver or spleen across time; 25-35% of these dogs had renal cortical echogenicity equal to that of the liver, but less than that of the spleen across time. Less than 3% of these dogs had renal cortical echogenicity greater than that of the liver, but less than that of the spleen. Only 1 (one) of these dogs had renal cortical echogenicity equal to that of the spleen and that occurred at only one of the 14 chronologic assessments. Therefore, in either mature or aged dogs imaged with 4.0 to 5.0 MHz equipment, the renal cortical echogenicity should be considered normal if it is less than or equal to that of the liver and less than that of the spleen. In 29 dogs imaged with the 4.0/5.0 MHz equipment and 6 dogs imaged with 7.5 MHz equipment, there was no significant diet or individual dog effect. The 7.5 MHz (6 dog) group had significantly higher average cortical echogenicity scores than the 4.0/5.0 MHz (29 dog) group. However, the occurrence of renal cortical echogenicity greater than liver echogenicity was seen in only 5 of 83 samples (approximately 6.0%) made on 6 dogs imaged with 7.5 MHz equipment and only 1 of 375 samples (approximately 0.27%) made on 29 dogs with 4.0/5.0 MHz equipment. With the exception of one occurrence, all dogs had renal medullary echogenicity less than that of the liver or spleen regardless of imaging equipment frequency. The renal medulla was always hypoechoic compared to the cortex.

Effects of diet and aging on renal measurements in uninephrectomized geriatric bitches

Under controlled, but varied dietary conditions among geriatric, uninephrectomized Beagle bitches (dogs) observed for 4 years, renal size increase as assessed radiographically and ultrasonographically occurred at variable rates, but on a seemingly continuous basis. The maximum observed mean renal linear parameter increase found was approximately 15%. However, a 10 and 15% increase is a more representative expectation among the 4 parameters (sonographic length, radiographic length, sonographic width, radiographic width) under consideration. The rate of renal size increase was rapid during the first 2 to 3 months following uninephrectomy. Thereafter, the rate of increase was slow, but occurred to varying degrees in both the length and width as assessed radiographically or ultrasonographically. The mechanism creating the size change was hypertrophy, not hyperplasia. Within limits of the 3 diets used in the study, no significant diet effect was found on the rate or degree of long term compensatory hypertrophy. Radiographically and ultrasonographically measured renal length had the greatest correlation with each other as well as with post mortem measurements and are, therefore, the recommended parameter for imaging assessment of compensatory hypertrophy. When the prenephrectomy, radiographic renal lengths and widths were normalized as a ratio of the second lumbar vertebral body length (L2) measured from ventrodorsal radiographs, the diet group means across dogs (approximately three L2 lengths for renal length; two L2 lengths for renal width) were in the middle of the respective previously published normal radiographic ranges for mature dogs (e.g. 2.5 L2 < or = length < or = 3.5 L2; 1.58 L2 < or = width < or = 2.38 L2 lengths). Even after the hypertrophic changes occurred, the radiographic group mean lengths and widths across dogs were still within the specified normal ranges, although toward the upper end of the respective range. This information provides background for clinical interpretation of potential compensatory hypertrophy that may be encountered following uninephrectomy for spontaneous disease in aged dogs. In addition, it appears that available radiographic renal linear ranges for normal mature dogs are applicable to geriatric dogs as well.

The use of polymeric liquid enteral diets for nutritional support in seriously ill or injured small animals: clinical results in 200 patients

This prospective, multicenter study evaluated the use of four polymeric liquid enteral (PLE) diets manufactured for dogs and cats in 200 ill or injured patients. Polymeric liquid enteral diets were administered by free-choice feeding, syringe, or feeding tube for up to 208 days. Overall results indicated a 4.9% incidence of vomiting in dogs and a 7.9% incidence in cats; an 8.9% incidence of diarrhea in dogs and an 18.4% incidence in cats. Patients fed the PLE diets seven days or longer had an average increase in body weight of 1.4% in dogs, an average decrease in body weight of 3.8% in cats, increases in lymphocyte counts, and mild decreases in serum albumin.

Transurethral prostatectomy--new trends

Treatment for benign prostatic hypertrophy has changed drastically within the past 3 years. Two new procedures-visual laser ablation of the prostate and transurethral electrovaporization prostatectomy, as well as improvements in the transurethral prostatectomy-have resulted in decreased recovery time and early discharge. Postoperative nursing observations for the visual laser ablation of the prostate and transurethral electrovaporization prostatectomy are quite different than for the transurethral prostatectomy. Discharge teaching has become extremely important because patients are now being discharged within 24 hours and most often with a Foley catheter. Patient response to the new procedures has been positive even though there are some disadvantages.

Relationship of maternal amino acids and proteins to fetal growth and mental development

The relationship of maternal amino acids, proteins, and certain other factors to fetal development (weight and cranial volume at birth and mental and motor scores at 8 months of age) was investigated in 129 gravidas. Maternal prepregnancy weight was significantly related to birth weight and cranial volume in the newborn. Among amino acids, glycine, lysine, and total amino acids were positively correlated with birth weight, whereas valine and threonine showed a negative correlation. Cranial volume at birth was significantly related to the level of glycine and alpha1 globulin. Other protein and amino acids which contributed to cranial volume included threonine, histidine, glutamic acid, and beta globulin, negatively correlated, whereas glutamine was positively correlated. Alpha1 globulin (negatively) and glycine (positively) made significant contributions to motor development. For mental development, alpha 1 globulin and histidine showed a negative correlation, whereas isoleucine was positively correlated. Findings indicated that the concentrations of certain maternal amino acids and proteins in the third trimester of pregnancy correlated significantly with fetal growth and development. This study suggests: (1) specific proteins or amino acids may be responsible for different developmental measures; (2) injudicious dietary restrictions in pregnancy should be avoided; (3) the determination of alpha1 globulin and a few amino acids such as glycine, lysine, and histidine in late pregancy may be used as predictors of fetal growth and development.

Respiratory distress syndrome in twins

Respiratory distress syndrome occurred in 77 of 1,130 liveborn twins (1: 15) and appears to be more frequent than in singletons. This increase cannot be entirely accounted for by the higher prematurity rate of twins over singletons. In 46 twin pairs with at least one affected, there was a significantly higher concordance rate among MZ than DZ pairs, suggesting that genetic factors are of some etiologic importance in this disease.

Effect of head position at birth on WISC verbal and performance IQ

To test the hypothesis that head position at birth is related to superiority of WISC Verbal (V) or Performance (P) IQ, head position at birth was determined for 212 Ss, including 95 sets of siblings. Children who were born Occiput Left (OL), that is, where the head was situated with the occiput in the left half of the maternal pelvis during delivery, were compared to children born Occiput Right (OR) for differences in WISC IQv and IQp. The results indicated that children born OR had a significantly lower IQv than IQp, but the OLs did not display such a significant difference. When same-sexed sibs were compared, it was found that the OR sib more frequently had higher IQp and lower IQv than his OL mate. No clear relationship was demonstrated for opposite-sexed sibling sets.

Learning impairment in rats administered a lipid free diet during pregnancy

Offspring ( N = 31) of 10 pregnant Wistar rats fed a fat free diet during pregnancy were compared with offspring ( N = 41) of 10 pregnant females fed a standard laboratory diet throughout pregnancy. The mean weight of the fat deprived offspring was less than for the controls ( p < .05) at time of birth but thereafter did not differ from the control Ss. Performance on the Lashley III maze for a food reward was significantly poorer for fat deprived Ss than for controls. The results suggest that brain maturation was irreversibly impaired by fat deprivation during prenatal life.