A description of travel medicine in general practice: a postal questionnaire survey

BACKGROUND: Travel-related diseases are important aspects of public health. The number of UK residents traveling abroad is increasing at a rate of 16% a year, thereby increasing exposure to travel-related morbidity. Provision of comprehensive pretravel health advice is essential to reduce this trend. In the UK, pretravel health advice is predominantly provided through general practices. METHODS: A postal questionnaire was sent to all 91 general practices in South Cheshire Health Authority. The questionnaires were to be completed by the lead advisor in travel medicine for each practice. Questions were asked on service provision, training and reference resources used, subjects advised on, and health promotion material used. Nonresponders were contacted and sent a further questionnaire. RESULTS: A response rate of 86% (78/91) was achieved. Of the lead advisors, 97% were nurses and 3% general practitioners. Thirty-eight sources of advice were quoted, the commonest of which comprised wall immunization charts (72%). Duration of consultation ranged from less than 5 min to over 30 min, with a median and mode of 11 to 15 min. Most respondents reported advising on most travel-associated risks, 40% of practices lacked a protocol, and 83% of providers had attended a training course on travel medicine for 2 days or less. CONCLUSIONS: This survey identified inadequacies of training and use of multiple sources of reference which may lead to inconsistencies in advice. Most practitioners could not define their workload in travel medicine. For effective protection of travelers, a careful risk assessment, clear risk communication and health education with detailed health promotion are necessary, but these are not likely to be provided within an average consultation time of 11 to 15 min. There is no evidence of consistent governance, planned training and monitoring of service quality of travel medicine practice. This may be due to lack of a national policy on best practice and guidance in this subject. National protocols with validated information resources, set standards of training, along with adequate consultation time for educating, advising, and prescribing, will lead to improved health of the traveling public.     

Tolerability of multiple vaccinations in travel medicine

BACKGROUND: Due to time constraints imposed by pending departure dates of travelers, the application of multiple vaccinations is commonly practiced in pretravel counseling. However, data regarding the tolerability of schedules with simultaneous vaccinations with different products are sparse. METHOD: In order to investigate effects of this practice, a prospective study was conducted with 1,183 healthy travelers who presented prior to their departure. Standardized questionnaires covering possible side effects were collected during and after vaccination. RESULTS: Results showed an increase of the overall frequency of side effects with an increasing number of simultaneously applied vaccines. In travelers with two or more vaccinations, side effects occurred less frequently than previously published. In double vaccinations, side effects occurred in 36.7% of vaccinees, triple vaccinations in 40.3%, in more than three vaccinations in 50.0%. Subjective rating by the vaccinees showed an excellent tolerability of multiple vaccinations. CONCLUSION: Multiple vaccines can be given at the same time with limited subjective side effects. These findings may increase the acceptability of vaccinations given in combination to travelers.     

Paediatric travel medicine: vaccines and medications

The paediatric aspects of travel medicine can be complex, and individual advice is often required. Nonetheless, children are much more likely to acquire common infections than exotic tropical diseases whilst travelling. Important exceptions are malaria and tuberculosis, which are more frequent and severe in children. Overall, travellers'' diarrhoea is the most common illness affecting travellers. This review discusses vaccines and medications that may be indicated for children who are travelling overseas. It focuses on immunizations that are given as part of the routine schedule, as well as those that are more specific to travel. Malaria and travellers'' diarrhoea are also discussed.     

Refining knowledge,attitude and practice of evidence-based medicine (EBM) among pharmacy students for professional challenges

Practicing evidence based medicine (EBM) is a professional need for the future clinical pharmacist in UAE and around the world. An attempt was made to evaluate pharmacy student’s knowledge, attitude and proficiency in the practice of EBM. A within-subject study design with pre and post survey and skill test were conducted using case based practice of EBM through a validated questionnaire. The results were tabulated and there was a statistically significant increase in pharmacy students’ perceived ability to go through steps of EBM, namely: formulating PICO questions (95.3%), searching for evidence (97%), appraising the evidence (81%), understanding statistics (78.1%), and applying evidence at point of care (81.2%). In this study, workshops and (Problem Based Learning) PBLs were used as a module of EBM teaching and practices, which has been shown to be an effective educational method in terms of improving students’ skills, knowledge and attitude toward EBM. Incorporating hands on experience, PBLs will become an impetus for developing EBM skills and critical appraisal of research evidence alongside routine clinical practice. This integration would constitute the cornerstone in lifting EBM in UAE up to the needed standards and would enable pharmacy students to become efficient pharmacists that rely on evidence in their health practice.     

Professionalism in the practice of medicine

Although medicine is universally recognized as the archetype of the professions, it can only be understood as part of the modern medical center, a dynamic social system consisting of the university, the hospital, the medical center and, most recently, corporate managed care. Such a view results in a portrait of medicine as a profession transformed, driven by huge and growing health care markets, its fate tied not only to state bureaucracies, but also to the dynamics of both health and non-health care businesses. The question asked here is how does such a radical change in medical practice affect medical education. Using methods of historical analysis, it appears that medical educators operate as though the educational process itself determines the values, and therefore the present and future behavior of their students. In other words, at the end of their formal education, doctors are fully formed professionals. However, from the analysis of this paper it can be concluded that the physician as an individual cannot function independently of the structure of the society and its general conception of the world. In the structure of medicine s present situation, the ethical standards of professionalism, as they are classically defined, cannot survive. Instead, modern medical graduates, much like their teachers and professional mentors, will be forced to adapt to a situation that is contradictory to the best traditions of medicine. How to stop this process is the urgent question. Three answers are presented.     

中医全科对推动全科医学发展的思考

全科医学在我国经过近二十年的探索和实践,取得了长足发展,但全科医学的宗旨尚无法在社区卫生服务中得到完全的实现。因此,如何缓解卫生保健的供需矛盾,提升初级卫生保健能力,实现全科医学的宗旨,已成为当前社区卫生服务需要思考的问题。结合当前社区卫生服务中心的现状以及我国医学教育的特点,我们认为,加强中医全科建设,是提升初级卫生保健能力、满足群众基本医疗服务需求,实现全科医学宗旨的一种积极探索。