Obesity Management: Australian General Practitioners’ Attitudes and Practices

Objectives: To document general practitioners’ (GPs) attitudes and practices regarding the prevention and management of overweight and obesity. Research Methods and Procedures: A cross‐sectional survey of a randomly selected sample of 1500 Australian GPs was conducted, of which 752 questionnaires were returned. The measures included views on weight management, definitions of success, views regarding the usefulness of drugs, approaches to and strategies recommended for weight management, and problems and frustrations in managing overweight and obesity. Results: GPs view weight management as important and feel they have an important role to play. Although they consider themselves to be well prepared to treat overweight patients, they believe that they have limited efficacy in weight management and find it professionally unrewarding. GPs view the assessment of a patient's dietary and physical activity habits and the provision of dietary and physical activity advice as very important. The approaches least likely to be considered important and/or least likely to be practiced were those that would support the patient in achieving and maintaining lifestyle change. Discussion: There remains considerable opportunity to improve the practice of GPs in their management of overweight and obesity. Although education is fundamental, it is important to acknowledge the constraints of the GPs’ existing working environment.     

住院医师/专科医师通科培训必要性的探讨

当前医学生临床实践活动在时间上不能保证,质量上又明显下滑的情况下,增加住院医师/专科医师通科培训是十分必要的。不仅能弥补临床实践的不足,而且也能为医学生向住院医师平稳顺利过度作铺垫。住院医师/专科医师培养是医学生向临床医师角色转换的一个重要的过度阶段,因此,培训时间、学习内容安排的科学、合理与否将直接影响培养效果。住院医师/专科医师通科培训应为培养具有较高临床综合能力的医学人才奠定基础。     

全科医生临床培养基地建设的实践与探讨

基于国家对全科医生培养基地建设的政策支持,分析了全科医生临床培养基地建设的意义。结合天津医科大学总医院全科医生基地建设的实践,提出大学医院应该充分发挥教学资源优势、医疗资源优势、辐射优势,培养合格全科医生,并就基地建设提出了拓展方案和预期效果。     

The post-infarction nurse practitioner project

Objectives To confirm the feasibility of nurse practitioner interventionin non-high-risk patients with recent myocardial infarction (MI). Design Observational study. Setting Acute coronary care unit in a teaching hospital. Methods We performed an open-label feasibility study to identify non-high-risk MI patients and evaluate the outcome of a new nurse practitioner intervention programme. The initial pilot phase served to identify the non-high-risk population. In the subsequent confirmation phase, 500 consecutive non-high-risk post-MI patients with preserved LV function without heart failure were included to receive nurse practitioner management. The nurse practitioner intervention started on transfer from the coronary care unit to the cardiology ward and continued thereafter for up to 30 days. Main outcome measures Time to first event analysis of death from all causes or repeat myocardial infarction. Results 500 Patients without signs of heart failure or depressed LV function were identified as nonhigh- risk and eligible for inclusion in the nurse practitioner intervention programme. In the implementation phase, none of the patients died and 0.9% developed a repeat myocardial infarction after 30 days of follow-up. Compared with the pilot phase, patients in the implementation phase spent fewer days in hospital (mean 11.1 versus 6.2 days; p<0.001). Conclusion It is feasible to identify non-high-risk post-MI patients, who can be managed adequately by a nurse practitioner. Embedding experienced nurse practitioners within critical care pathways may result in significant decreases in length of hospital stay. (Neth Heart J 2009;17:61-7.)     

Research in general practice: a survey of incentives and disincentives for research participation

Background Recruitment rates of general practitioners (GPs) to do research vary widely. This may be related to the ability of a study to incorporate incentives for GPs and minimise barriers to participation.Method A convenience sample of 30 GPs, ten each from the Sydney intervention and control groups Ageing in General Practice ‘Detection and Management of Dementia’ project (GP project) and 10 GPs who had refused participation, were recruited to determine incentives and barriers to participating in research. GPs completed the 11-item ‘Meeting the challenges of research in general practice: general practitioner questionnaire’ (GP survey) between months 15 and 24 of the GP project, and received brief qualitative interviews from a research GP to clarify responses where possible.Results The most important incentives the 30 GPs gave for participating in the project were a desire to update knowledge (endorsed by 70%), to help patients (70%), and altruism (60%). Lack of time (43%) was the main barrier. GPs also commented on excessive paperwork and an inadequate explanation of research.Conclusions While a desire to update knowledge and help patients as well as altruism were incentives, time burden was the primary barrier and was likely related to extensive paperwork. Future recruitment may be improved by minimising time burden, making studies simpler with online data entry, offering remuneration and using a GP recruiter.     

新时期大型综合医院创新文化建设平台的实践与思考

创新医院文化建设平台是新时期医疗服务的客观需要。以北京大学第一医院近年来创新文化建设平台的具体实践为例,通过分析新型平台在实际应用过程中的效果和意义,探讨新时期大型综合医院创新文化建设平台的必要性与可行性,研究文化建设促进大型综合医院全面、协调、可持续发展的新思路,阐述了创新医院文化建设平台的效果和意义。     

理论与实践交互渗透培养方案对实习护士的培训效果

目的 探究理论与实践交互渗透培养方案对普外科实习护士的培训效果。 方法 2013年4月—2014年4月期间60例普外科室实习护士进行培训,实验组采取理论与实践交互渗透培养方案,对照组采取常规培养方案。对两组学员培训前、培训后的理论成绩、操作成绩、患者对学员的满意度以及学员队培训方案满意度进行比较。 结果 培训后,实验组的理论成绩为（91.18±3.61） 分,对照组为（82.73±4.84） 分;实验组的操作成绩为（97.34±1.15） 分,对照组为（91.75±2.12） 分。患者对实验组的沟通能力、观察力、主动服务能力、职业操作规范性、职业道德的满意度均高于对照组。实验组学员对本次培训方案的满意度为100.00%,对照组学员的满意度为83.33%。经比较以上项目均具有显著差异,具有统计学意义（P<0.05）。 结论 理论与实践交互渗透培养方案更有利于提高普外科室实习护士的培训效果,学员的满意度更高,值得广泛推广。     

公立综合性医院在突发灾难事件医疗救援中的伦理实践

突发灾难中的医疗救援不同于常规的医疗救治,其具有显著的特殊性。而这种特殊性不仅体现在救援组织、医疗技术上,还体现在公立医院医疗救援应遵守的伦理原则上。突发灾难事件下公立综合性医院应突破因情况特殊性而带来的医疗救援伦理局限性,使其得到充分合理转化和运用。     

遗传负荷理论的一种普适框架

遗传负荷表示种群由于遗传变异能力的存在而在平均适宜度上的损失,定量讨论各种遗传负荷,对研究现实发生水平上的物种进化具有重要意义,以往的遗传负荷理论从种群平衡出发,探讨现实发生水平上的物种进化,可是,进化是种群平衡的位移;这便构成了理论与现实之间的矛盾,为拓展以往的遗传负荷理论,给出了一个描述各种遗传负荷的普适理论框架,利用这个理论框架既能探讨平衡种群的遗传负荷,又能模写非平衡种群的遗传负荷及其变化,从而克服了以往的遗传负荷理论不能描述非平衡种群和不时与生物进化现实相悖的不足之处,为研究物种的进化提供了一种可靠的模拟方法。     

The Impact of Obesity on Primary Care Visits

Objective: To investigate the influence of patient obesity on primary care physician practice style. Research Methods and Procedures: This was a randomized, prospective study of 509 patients assigned for care by 105 primary care resident physicians. Patient data collected included sociodemographic information, self‐reported health status (Medical Outcomes Study Short Form‐36), evaluation for depression (Beck Depression Index), and satisfaction. Height and weight were measured to calculate the BMI. Videotapes of the visits were analyzed using the Davis Observation Code (DOC). Results: Regression equations were estimated relating obesity to visit length, each of the 20 individual DOC codes, and the six DOC Physician Practice Behavior Clusters, controlling for patient health status and sociodemographics. Obesity was not significantly associated with the length of the visit, but influenced what happened during the visit. Physicians spent less time educating obese patients about their health (p = 0.0062) and more time discussing exercise (p = 0.0075). Obesity was not related to discussions regarding nutrition. Physicians spent a greater portion of the visit on technical tasks when the patient was obese (p = 0.0528). Mean pre‐visit general satisfaction for obese patients was significantly lower than for non‐obese patients (p = 0.0069); however, there was no difference in post‐visit patient satisfaction. Discussion: Patient obesity impacts the medical visit. Further research can promote a greater understanding of the relationships between obese patients and their physicians.