News in brief

Assessment collaboration in medical schools “viable”
NEW data demonstrated the viability of the Australian Medical Schools Assessment Collaboration (AMSAC) to link assessments across medical schools to set collaborative benchmarks for student performance, according to the authors of a study published in the MJA. The authors described AMSCA as a broad collaboration between medical schools with varying student numbers, selection criteria, course duration and syllabus content. The number of medical schools and students taking part in AMSAC had more than doubled between 2009 and 2013. The research included a retrospective analysis of the performance of 6401 preclinical students from 13 medical schools from 2011‒2013. The researchers found graduate-entry students performed better than those entering straight from high school, and students at large medical colleges scored higher than those at small schools but that, in both cases, the effect size was small. They concluded that as few as 25 common items were required to generate reliable, interschool comparisons from the AMSAC data. AMSAC allowed participating schools to compare their students’ knowledge base and reasoning skills with a national average. “Early fears about data being misused to create league tables or unique syllabus content being damaged have not been realised”, the authors wrote. “The project is a model for national collaboration between medical schools to meet government and community demands for accountability without loss of school autonomy.”

Harms and benefits with oseltamivir for flu
AN individual patient data meta-analysis for all clinical trials comparing oseltamivir (Tamiflu) with placebo for treatment of seasonal influenza in adults has found it reduces the risk of lower respiratory tract complications and hospital admission, but increases rates of nausea and vomiting. The research, published in The Lancet, included data for 4328 patients from nine trials. Of the 2402 study participants randomly assigned to receive 75 mg oseltamivir twice a day, 66% were influenza infected — most with influenza virus type A — compared with 68% of the 1926 participants in the placebo group. In the oseltamivir group the researchers found a 21% shorter time to alleviation of all symptoms compared with placebo. The researchers wrote that an estimated 44% reduction in risk of lower respiratory tract complications was attributable to oseltamivir treatment, which included 56 (3.6%) versus 87 (6.9%) for bronchitis, nine (0.6%) versus 21 (1.7%) for pneumonia, and one (0.1%) versus four (0.3%) for lower respiratory tract infection in the oseltamivir and placebo groups, respectively. “The balance of benefits and harms becomes less favourable if more non-infected participants are treated with oseltamivir”, the researchers wrote, saying whether the magnitude of the benefits outweighed the harms attributed to nausea and vomiting “needs to be carefully considered”. An accompanying editorial said the research showed the benefits accrued only in laboratory-confirmed cases of influenza. Rapid diagnostic testing, if available, was advisable before prescribing oseltamivir in routine clinical practice, the editorial said.

Eye injury audit highlights need for prevention
THE importance of prevention of, and early treatment for, chemical eye injuries has been highlighted in a letter to the MJA. The authors described the results of a retrospective audit to determine the characteristics, management and outcomes of chemical eye injuries in 176 patients who presented to the Royal Victorian Eye and Ear Hospital. The average age of the patients was 41 years and 62.5% were male. The authors found 82 injuries occurred at home and 65 in the workplace, with 36.9% of injuries sustained while patients were cleaning. At the time of injury, 123 patients were not wearing eye protection, and nine wore spectacles. The causative agent was alkaline in 64.8% of cases. Most injuries were mild, and all injuries were managed medically, the authors wrote. The median visual acuity at discharge was 6/6. One injury was complicated by corneal scarring. Although patients were aware of the importance of irrigation, many did not receive adequate irrigation, the authors found. They said their study highlighted the need for a greater awareness of prevention and early treatment strategies, including “increased awareness of the dangers of chemicals, careful handling of chemicals, wearing of protective eye-wear, and immediate irrigation after injury”. These important public health messages needed to be continually emphasised, the authors wrote.

Cases of nocturnal leg cramps double in summer
RESEARCH based on quinine prescriptions and internet searches related to nocturnal leg cramps has found they are seasonal, with double the number of cases in summer than in winter. The Canadian research, published in CMAJ, used prescription data for patients aged 50 years and older and Google trends data from 2004 to 2012. They found 31 339 patients started quinine treatment between 2001 and 2007. The researchers wrote that seasonality explained 88% of the variability in quinine prescriptions and 72% of the variability in Internet search volume. “The timing of the seasonal cycle was identical for both outcomes, with the peak of new prescriptions and Internet search volume occurring in mid-July (i.e., mid-summer) and the valley of both outcomes occurring in mid-January (mid-winter)”, they wrote. They noted that during the selected period of available quinine data, some drug regulatory bodies (the US Food and Drug Administration and its counterparts in Australia and New Zealand) had warned against using quinine for the treatment of nocturnal leg cramps based on reports of serious adverse events, but this had not affected quinine use. In an accompanying editorial the author wrote that although quinine was “modestly effective” for nocturnal leg cramps, it was not recommended for routine use because of safety concerns.

Fast-food menu labels influence parent choices
FAST-food menu labels displaying food energy in physical activity calorie equivalents (PACE) may influence parents to order meals with a lower calorie count and encourage their children to exercise, according to US research. The study, published in Pediatrics, included a national web-based survey of 823 parents randomly assigned to one of four fast-food menus: no label, calories only, calories plus minutes to walk to burn the calories in the food item, or calories plus miles to walk to burn the calories in the food item. Participants were asked to imagine they were at a fast-food restaurant and to place a hypothetical order for their child (average age 9.5 years). Parents with menus that displayed no label ordered an average of 1294 calories, whereas those shown calories only, calories plus minutes, or calories plus miles ordered 1066, 1060 and 1099 calorie meals, respectively. Only 20% of parents reported that labels which just listed calories were “very likely” to prompt them to encourage their children to exercise, compared with 38% for calories plus minutes and 37% for calories plus miles, the authors wrote. They said their study was the first to examine the possible effect of PACE labelling on parent decisions for their children. “The potentially resulting combination of fewer calories consumed with greater physical activity could help begin to curb childhood obesity. Real-world research is needed to evaluate the effects of PACE labeling for adults and children”, the authors wrote.