Alaska medicine最新文献

Several recent physician workforce reports in Alaska have called for a rapid increase in the number of state-supported medical school positions to between 30 and 50 new students per year, preferably through WWAMI--Alaska's Medical School. Here we compare the number of clinical experiences for undergraduate and graduate medical education in Alaska as compared with other states to determine if they are likely to be limiting factors for expansion. Data were primarily gathered from the Association of American Medical Colleges, the Accreditation Council for Graduate Medical Education and from Alaska WWAMI. The data demonstrate that: 1) Alaska currently supports far fewer medical student clerkship experiences per capita than other states; 2) Alaska currently supports far fewer medical residents per capita than other states; 3) neither of these is due to an inadequate physician workforce to provide the training, using other states as a standard; and 4) clinical experiences should not be a limiting factor for expansion of medical education in the state.

MoM hip bearings are being scrutinized due to high early failure rates and concerns that the results of the revision surgeries will be poor. However, orthopedic surgeons and the general medical community are unaware that patients with MoM bearings are also at risk for cobaltism. Medical providers need to know that hip arthroplasty implantees that present with symptom complexes that include tinnitus, deafness, vertigo, visual changes, rashes, hypothyroidism, tremor, dyspnea on exertion, mood disorders, dementia, heart failure, and peripheral neuropathy may be presenting arthroprosthetic cobaltism. These patients need to be asked if they have had a hip replacement and if so what type. For those patients implanted with a MoM bearing or those with a history of hip revision for a failed ceramic bearing obtaining a [Co] is indicated. MoM implantees with renal failure are a particularly high risk for cobaltism. A [Co] can be measured by many reference laboratories from royal blue top trace elements tube of venous blood. Venipuncture with a standard needle is adequate as long as a red stoppered tube is drawn first. The radiographic appearance of a MoM bearing is readily apparent to an orthopedic surgeon. The patient's operative report will usually specify the bearing type. Given that the publicity of the recent ASR bearing recall medical providers will be contacted by worried patients concerned about their hip implants. Most patients with hip replacements will not know the brand or material of their bearings. Providing patients with copies of their hip implant inventory might avoid worry by the majority of patients with hip arthroplasties that are not at risk. Patients with a cobalt levels of greater than 7 mcg/l bear observation of neurologic and cardiac function. Those patients with levels greater than 20 should be advised to have revision of their hip arthroplasty to a bearing that eliminates cobalt. Most patients implanted with MoM bearing have cobalt levels greater than those allowed in industry and cobalt exposed workers may have an increased incidence of subclinical cognitive and cardiac impairments. This association merits further study. Table 1 is a summation of the previously referenced data of this paper that might assist the clinician in interpreting a [Co].

Several recent physician workforce reports in Alaska have called for a rapid increase in the number of state-supported medical school positions to between 30 and 50 new students per year, preferably through WWAMI - Alaska's Medical School. Here we compare applicant and matriculant data for Alaska WWAMI and for Alaskans applying to all U.S. allopathic medical schools to national applicant and matriculant trends gathered from databases of the Association of American Medical Colleges. The assessment demonstrates that 1) changes in the number of Alaska WWAMI applicants parallels changes in the number of Alaskans applying to all U.S. medical schools, but these do not track changes in the national applicant pool, 2) historical records suggest that a fundamental change is needed to provide an applicant pool to support a class size of 50 within the next decade, 3) smaller states with independent, four-year medical schools generate more medical school applicants per capita than Alaska.