Cancer: improving early detection and prevention. A community practice randomised trial.
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OBJECTIVE: To test the impact of physician education and facilitator assisted office system interventions on cancer early detection and preventive services. DESIGN: A randomised trial of two interventions alone and in combination. SETTING AND SUBJECTS: Physicians in 98 ambulatory care practices in the United States. INTERVENTIONS: The education intervention consisted of a day long physician meeting directed at improving knowledge, attitudes, and skills relevant to cancer prevention and early detection. The office system intervention consisted of assistance from a project facilitator in establishing routines for providing needed services. These routines included division of responsibilities for providing services among physicians and their staff and the use of medical record flow sheets. MAIN OUTCOME MEASURES: The proportions of patients provided the cancer prevention and early detection services indicated annually according to the US National Cancer Institute. RESULTS: Based on cross sectional patient surveys, the office system intervention was associated with an increase in mammography, the recommendation to do breast self examination, clinical breast examination, faecal occult blood testing, advice to quit smoking, and the recommendation to decrease dietary fat. Education was associated only with an increase in mammography. Record review for a patient cohort confirmed cross sectional survey findings regarding the office system for mammography and faecal occult blood testing. CONCLUSION: Community practices assisted by a facilitator in the development and implementation of an office system can substantially improve provision of cancer early detection and preventive services. (+info)
Active precepting in the residency clinic: a pilot study of a new model.
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OBJECTIVE: This study's objective was to develop and implement a model of "active precepting" as a teaching and patient care quality improvement project at a community-based family medicine residency program. METHODS: The Prepare, Orchestrate, Educate, Review (POwER) model was developed with input from faculty, students, residents, and staff. Five measures of conformance to the model were monitored with daily feedback cards from November 2001 to February 2002. Faculty, residents, and clinic staff were surveyed and interviewed after the intervention for perceptions about active precepting. Two follow-up patient flow studies were completed for concomitant quality improvement efforts, and those findings were reviewed along with intervention findings. RESULTS: Preceptors reported reviewing resident schedules prior to clinic sessions more often after the model was put in place, and clinic staff reported that residents and faculty were more willing to help solve problems. Concurrent flow studies showed that patient time in clinic decreased from 110 minutes before the intervention to < 70 minutes after, while resident time with patients, including precepting time, decreased from 44 minutes to < 30 minutes. CONCLUSIONS: Our results point to the potential of the POwER model of active precepting to contribute to improved patient care, teaching, stakeholder satisfaction, and better flow in the family medicine teaching clinic. (+info)
Public health education: a report from Mosul and a plan for change.
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BACKGROUND: Today Iraq suffers from severe shortages of food, medicine, clean water and adequate sanitation. Malnutrition and communicable diseases are major factors in the rising morbidity and mortality rates. However, supplies and equipment are insufficient or outmoded, and public health training is outdated. The Universities have been unable to help because under-funding and isolation from their professional colleagues has limited their effectiveness. METHODS: To revitalize public health education, we describe a partnership between a US education consortium and the University of Mosul that will be carried out in the next several years. The plan is based on "three R's": Recovery from the past damage due to war and neglect; Retooling of key public health faculty to remedy the years of isolation and restriction of activity; and Reestablishment of the University as a resource for the its constituents, for the community and for other educational institutions. In all these activities, Iraqi minorities, especially women, will participate and contribute. CONCLUSION: The work to repair the public health educational infrastructure has just begun. When completed, it will represent a small but necessary step in restoring normalcy to the people of Mosul, and of Iraq. (+info)
The incidence and natural history of Raynaud's phenomenon in the community.
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OBJECTIVE: Raynaud's phenomenon (RP) is a common disorder, yet its incidence and natural history are unknown. Our objective was to determine the incidence and natural history of RP not associated with a connective tissue disease in a large, community-based population. METHODS: Using serial examinations of the Framingham Heart Study offspring cohort, we collected data regarding RP symptoms for 717 women and 641 men over a 7-year period. We used validated criteria for RP classification and categorized participants as having incident, persistent, or remitted RP. We performed sex-specific analyses of RP status by age, body mass index, vibratory tool use, season of examination, state of residence, use of antihypertensive medications, and smoking status. RESULTS: The mean +/- SD age of participants was 53.5 +/- 10 years. The incidence of RP was 2.2% in women (n = 14) and 1.5% in men (n = 9). Of the 78 women and 50 men who had RP at baseline, 36% of women (n = 28) and 36% of men (n = 18) had persistent RP. RP remitted in 64% of women (n = 50) and 64% of men (n = 32), with 41 women and 25 men meeting no or only 1 RP criterion at followup. RP episodes were infrequent and rarely interfered with daily activities. CONCLUSION: This is the first prospective study to determine the incidence and natural history of RP in a community-based cohort. Our data demonstrate that RP not associated with a connective tissue disease is frequently a transient phenomenon and rarely interferes with daily activities. (+info)
Frequency of alcohol use and obesity in community medicine patients.
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BACKGROUND: Obesity is an important public health problem. However, the effects of alcohol use on the risk for obesity have not been thoroughly explored. This study focuses on how frequency of alcohol use is related to the risk of obesity in a community medicine clinic population. METHODS: This study used a cross-sectional survey to test the hypothesis that obesity (BMI > 30) is associated with alcohol use. The convenience sample was drawn from three clinics that primarily serve low-income populations. Independent variables included frequency of alcohol use, frequency of binge drinking, demographic characteristics, health behaviors and health status. RESULTS: In comparison to non-drinkers, people who consumed alcohol 3 or more days per month had lower odds of being obese (Adjusted Odds Ratio = .49, p < .04). As expected, there was a significant association between watching eight or more hours of television per day and obesity (AOR = 2.34, p < .01). CONCLUSION: More frequent drinking and less television time are independently associated with reduced odds of obesity in this sample of community medicine patients. Additional research is needed to isolate casual mechanisms. (+info)
Teaching community, occupational and family medicine at the National University of Singapore: past, present and future.
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INTRODUCTION: We describe how the curriculum of community, occupational and family medicine (COFM) has evolved in response to social and educational forces and local health needs. Challenges in the teaching of the curriculum are also discussed. CURRICULUM: The COFM Department aims to produce medical undergraduates and graduates with the skills to critically appraise evidence, prevent and manage diseases, and promote health in the community and primary healthcare setting. Its teaching programmes consist of the medical undergraduate programme and the Master of Medicine programmes in Occupational Medicine, Public Health and Family Medicine. The undergraduate modules consist of evidence-based medicine, public health in the community, disease prevention and control, occupational medicine practice, health promotion and behaviour, and communication with patients. The university's first completely online module on SARS was jointly implemented by the Department and the Centre for Instructional Technology for the entire student population last year. The COFM curriculum has shifted from giving students factual information through lectures to developing students' critical thinking and problem-solving skills through small group teaching, case studies and community health projects. Innovative assessment methods such as open-book examinations; objective structured communication stations with simulated patients; and evaluation of students' participation in group work are used to assess students' skills in problem-solving, communication and teamwork respectively. CONCLUSION: While the Department has made significant progress in developing a relevant and updated curriculum based on appropriate learning and assessment approaches, it will strive to do more to develop students' critical thinking skills by using newer approaches. (+info)
Evaluation of a task-based community oriented teaching model in family medicine for undergraduate medical students in Iraq.
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BACKGROUND: The inclusion of family medicine in medical school curricula is essential for producing competent general practitioners. The aim of this study is to evaluate a task-based, community oriented teaching model of family medicine for undergraduate students in Iraqi medical schools. METHODS: An innovative training model in family medicine was developed based upon tasks regularly performed by family physicians providing health care services at the Primary Health Care Centre (PHCC) in Mosul, Iraq. Participants were medical students enrolled in their final clinical year. Students were assigned to one of two groups. The implementation group (28 students) was exposed to the experimental model and the control group (56 students) received the standard teaching curriculum. The study took place at the Mosul College of Medicine and at the Al-Hadba PHCC in Mosul, Iraq, during the academic year 1999-2000. Pre- and post-exposure evaluations comparing the intervention group with the control group were conducted using a variety of assessment tools. RESULTS: The primary endpoints were improvement in knowledge of family medicine and development of essential performance skills. Results showed that the implementation group experienced a significant increase in knowledge and performance skills after exposure to the model and in comparison with the control group. Assessment of the model by participating students revealed a high degree of satisfaction with the planning, organization, and implementation of the intervention activities. Students also highly rated the relevancy of the intervention for future work. CONCLUSION: A model on PHCC training in family medicine is essential for all Iraqi medical schools. The model is to be implemented by various relevant departments until Departments of Family medicine are established. (+info)
Ultrasonic measurement of the elastic modulus of the common carotid artery. The Atherosclerosis Risk in Communities (ARIC) Study.
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BACKGROUND AND PURPOSE: The Atherosclerosis Risk in Communities Study is a prospective investigation of the etiology and natural history of atherosclerosis and the etiology of clinical disease in four US communities. METHODS: Noninvasive ultrasonic methods were used to determine mean wall thickness (WT), radius (R), and circumferential arterial strain (CAS) in the left common carotid artery of 3,321 white male and female study participants between the ages of 45 and 64 years. The mean and standard deviation of Young's elastic modulus (Y) in 5-year age groups were determined for each sex by combining the ultrasonic data with concurrent noninvasive measurements of pulse pressure (PP) in the right brachial artery using the equation Y = (R/WT) x (PP/CAS). RESULTS: Significant (p = 0.0001) age group differences in Y were observed in both sexes, with the mean value increasing from 701 kPa in women and 771 kPa in men in the 45-49-year-old age group to 965 and 983 kPa, respectively, in the 60-64-year-old age group. Significant (p = 0.0001) age group differences were also observed for WT, the WT/R ratio, PP, CAS, and the PP/CAS ratio in both sexes. A sex difference in Y was detected (male greater than female, p = 0.0006) only in the 45-49-year-old age group. Significant (p less than 0.0001) sex differences were found, with men having a greater lumen diameter calculated as 2 x (R - WT), a greater WT, and a greater 2R in all age groups. The WT/R ratio did not differ in both sexes in all age groups. CONCLUSIONS: Knowledge of the arterial wall elastic modulus and the parameters required for its determination can provide important insight into structural changes occurring within the arterial wall with age and sex, and possibly with the onset of very early arterial disease. (+info)