A randomized trial to improve self-management practices of adults with asthma

Article Abstract:

Asthma affects approximately three to six percent of the adult population of the United States. Failure to adhere to treatment regimens for this condition is a significant problem; adherence to the prescribed medication regimen is about 30 to 40 percent. In addition, only 11 percent of a group of patients studied used aerosol inhalers correctly. The University of Alabama developed an Asthma Self-Management Program to examine and study the self-management practices of adults with asthma. The 124 patients who received the Self-Management Program had generally better adherence to medication than 101 usual care patients. The program had a positive but limited effect on functional status. Both groups had a decrease in emergency department and hospital visits. It is possible that health care overutilization decreased due to the information about asthma that patients acquired during the study. The program was conducted in a university medical center setting and many health care support personnel were available to participants. This type of program needs to be developed in other settings. Designing a self-management program is difficult and a balance needs to be established in the amount of information that patients need. It is often tempting to give more information than is essential. Additional research is needed to determine the minimum program activities and to improve self-management practices. All patients with asthma should receive a self-management program, not just the most problematic ones or those with the most severe asthma. Longer follow-up must also be conducted to determine if the positive and beneficial effects can be maintained or enhanced. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Innovations, Patient compliance, Asthma, Patient education, Asthmatics

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Nutrition training in graduate medical (residency) education: a survey of selected training programs

Article Abstract:

Even though it is clear that proper nutrition plays an important role in maintaining health and preventing disease, many residents and practicing physicians have had limited training in clinical nutrition. A study was performed to identify the important features of clinical nutrition programs that have proven to be the most effective for teaching nutrition to residents. To accomplish this task, 238 nutrition educators and 787 residency-program directors were asked to identify the top nutrition programs in the country. Surveys were conducted at 23 institutions with the best programs, and seven of these institutions were visited. The results of the survey indicate that the key element to successful training of residents in clinical nutrition is the presence of an active physician-nutritionist role model. It is important to have a physician who is actively involved in patient care assume a leadership role as a nutrition expert to emphasize the nutritional aspects of disease. The second most important feature is a multidisciplinary nutrition-support team to provide education for the residents. Clinical rotations or electives in nutrition are an important part of the training experience. The curriculum should include lectures and conferences in addition to clinical activities that allow the residents to have first-hand experience with patients. A strong academic environment is important for attracting topnotch faculty. (Consumer Summary produced by Reliance Medical Information, Inc.)

Curricula, Study and teaching, Nutrition, Residents (Medicine), Medical education

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Effectiveness of Agency for Health Care Policy and Research clinical practice guideline and patient education methods for pregnant smokers in Medicaid maternity care

Article Abstract:

A practice guideline produced by the Agency for Health Care Policy and Research doubled the smoking cessation rate in a study of 265 pregnant smokers covered by Medicaid. The guidelines were combined with a video and a brief counseling session.

Smoking cessation programs, Smoking cessation, Practice guidelines (Medicine)

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