The effect of a computer-generated patient-held medical record summary and/or a written personal health record on patients' attitudes, knowledge and behaviour concerning health promotion

OBJECTIVE: The aim of the study was to examine the effect of a computer-generatedpatient-held medical record summary (CHR) and/or a written personalhealth record (PHR) on patients' attitudes, knowledge and behaviourconcerning health promotion. METHOD: It was conducted in five general practices in Oxfordshire. Patientsaged 25–65 years in each practice were randomly assignedto receive either a CHR plus PHR, CHR only, PHR only, or nopersonal record. Patients were recruited by mail (one practice)or opportunistically by nurses (four practices). Health checkswere carried out using the randomly assigned record, which thepatient retained. Attitudes to patient-held records, and pre-and post-intervention knowledge and behaviour concerning healthpromotion, were assessed using questionnaires. Only those whoresponded to ‘before’ and ‘after’ questionnaireswere included in the analysis. RESULTS: A sample of 261 patients was obtained from mail recruitmentand 103 from opportunistic nurse recruitment. Patients receivinga CHR as part of mail recruitment were significantly more likelyto attend for a health check (P = 0.016). Those receiving bothPHR and CHR were more likely to keep (P = 0.014) and use (P= 0.029) the record. Those receiving PHR as part of the packageimproved their knowledge of health promotion and became moreaware of and more likely to change their life-style (P = 0.022). CONCLUSIONS: The effectiveness of a computer-generated patient-held healthsummary and an explanatory booklet together is greater thaneither separately in changing patients' knowledge attitudesand behaviour concerning health promotion. Keywords. Patient-held record, primary care, health promotion, computerized medical record.     

Dietary and exercise assessment in general practice

BACKGROUND: Diet and physical activity are important in many conditionsmanaged in primary care. Dietary and physical activity assessmentis complex, has inherent inaccuracies related to self-reporting,and is only a small part of a larger context of developing effectiveintervention in primary care. However, for personalized assessmentin routine clinical care, and for the assessment of differentintervention strategies in a general practice research setting,validated life-style assessment tools are needed. OBJECTIVE: We aimed to discuss the requirements for assessment tools andto identify feasible validated assessment instruments for usein primary care. METHODS: Potential tools were identified from a Medline search, UK ResearchIntelligence, and contact with groups known to be working inthe area. RESULTS: Several brief instruments assess mainly fat in the US diet butthe limited range of foods covered and the setting of studieslimits their generalizability. Only one tool developed for UKuse—‘DINE’, which scores total fat, fibreand unsaturated fat—was identified which is both feasibleand has documented reasonable validated characteristics. Evenfor this tool there are doubts about the validation ‘standard’.No diet or physical activity validation studies have used bothsubjects and health professionals from general practice settings. CONCLUSION: There are very few feasible and validated dietary or physicalactivity assessment tools for use in clinical care or researchin general practice, and doubts about the design and settingsof published validation studies. Further research is neededto validate and develop a range of feasible life-style assessmenttools with specified time and training requirements for usein primary care. Keywords. Nutrition assessment, primary health care, exercises.     

Colorectal cancer and polyps in patients aged 40 years and over who consult a GP with rectal bleeding

BACKGROUND: Rectal bleeding is common in the community and in general practice,but few studies have examined the causes of rectal bleedingin patients presenting to general practitioners. OBJECTIVE: To determine the frequency of neoplastic conditions in patientswith rectal bleeding presenting in general practice and to explainthe associations between presenting symptoms and final diagnoses. METHODS: We conducted two studies, the first in 1989, the second in 1991,in which we invited Danish general practitioners to register3–4 patients aged 40 and over presenting with rectal bleeding. RESULTS: In Study 1 among 208 patients aged 40 and over and presentingwith a first episode of rectal bleeding, colorectal cancer andpolyps were present in 15.4 and 7.7%, respectively. In Study2 among 209 patients aged 40 and over and presenting with overtrectal bleeding, 156 reported a first bleeding episode or achange in their usual bleeding pattern, and in this group colorectalcancer and polyps were diagnosed in 14.1 and 11.5%, respectively.In the group with unchanged bleeding the cancer polyp prevalencewas 6.7% (P < 0.05). The patients in both studies were followedthrough a yearly letter to the GP for at least 32 and 22 months,respectively. CONCLUSIONS: A joint analysis of the two study populations showed that onlyage and change in bowel habit contributed to differentiatingthe cancer from the non-cancer patients. Keywords. Colorectal cancer, polyps, rectal bleeding.     

Effects of instruction by practice assistants on inhaler technique and respiratory symptoms of patients. A controlled randomized videotaped intervention study

BACKGROUND: Many patients with asthma or chronic obstructive pulmonary diseaseuse their medication inhalers incorrectly. General practitioners,pharmacists and other health care providers do not always havethe opportunity to instruct patients in correct inhaler technique. OBJECTIVE: To find out whether the inhaler technique and respiratory symptomsof patients can be improved after instruction by practice assistants. METHODS: Single blind, randomized intervention study in which 48 patientswho had been using a dry powder inhaler for at least one monthtook part. Their inhaler technique was videotaped on two visitswith a two-week interval between visits. The inhaler techniqueon the videos was subsequently scored by two experts on ninecriteria. At both visits the patients completed a questionnaireabout their respiratory symptoms. After the first video, 25patients were randomly chosen to receive instruction from oneof six practice assistants who had followed a one evening courseabout inhaler instruction, and who had been issued an instruction-set. RESULTS: The patients who received instruction had a significantly greaterreduction in number of mistakes at the second visit than thepatients who did not (P = 0.01). The instructed patients alsoreported less dyspnoea at the second visit (P = 0.03). No effectof instruction was found on wheezing, cough and sputum production. CONCLUSION: The inhaler technique of patients can be improved significantlyby the instruction of patients by trained practice assistants,possibly resulting in less dyspnoea. Keywords. Administration-inhalation, obstructive lung diseases, airways symptoms, patient-education, general practice.     

A randomised trial of the short-term effect of a minimal nutrition intervention in general practice

OBJECTIVE: To test the effectiveness of a minimal nutrition intervention to increase dietary intake of folate. METHOD: Randomised controlled trial in the general practice setting of personalized, face-to-face feedback with educational materials to increase dietary intake of folate. RESULTS: One hundred and nine intervention and 94 control subjects completed baseline and follow-up assessments within the study period. At baseline (August-October 2004), there were no significant differences in folate intake scores between the intervention and control groups. At the eight-week follow-up, the mean folate intake score in the intervention group was significantly higher than in the control group, indicating that the nutrition intervention significantly increased reported dietary intake of folate. CONCLUSION: Presenting individual dietary feedback in conjunction with educational materials in the general practice setting is an effective way of changing dietary behaviour. IMPLICATIONS: The present study suggests a way in which health-related dietary change may be encouraged on a large scale without incurring a large cost.     

Nutrition screening of older people in a community general practice, using the MNA-SF

Background: Objective

The study aimed to determine the prevalence of malnutrition risk in a population of older people (aged 75 years and over) attending a community general practice and identify characteristics of those classified as malnourished or at risk of malnutrition.

Design

Cross-sectional study of nutritional risk screen conducted over a six month period.

Participants and setting

Patients attending a general practice clinic in Victoria, Australia, who attended for the “75 plus” health assessment check.

Measurements

The Mini Nutritional Assessment Short Form (MNA®-SF) was included as part of the health assessment. Information was collected on living situation, co-morbidities, independence with meal preparation and eating, number of medications. Height and weight was measured and MNA®-SF score recorded.

Results

Two hundred and twenty five patients attending a general practice for a health assessment with a mean age of 81.3(4.3)(SD) years, 52% female and 34% living alone. Only one patient was categorised by the MNA®-SF as malnourished, with an additional 16% classified as at risk of malnutrition. The mean Body Mass Index (BMI) of the at-risk group was significantly lower than the well-nourished group (23.6 ± 0.8 (SEM) vs 27.4 ± 0.3; p=0.0001). However, 34% of the at-risk group had a BMI of 25 or more with only 13% in the underweight category.

Conclusion

In this population of older adults attending their general practitioner for an annual health assessment, one in six were identified as being at nutritional risk which is an additional risk factor for a severe health issue. Importantly, one third of the at-risk group had a BMI in the overweight or obese category, highlighting that older people can be at nutritional risk although they may be overweight or obese.     

Stability of dietary patterns in young women over a 2-year period

OBJECTIVE: To examine the stability of dietary patterns in young women over a two-year period and to identify factors that influence stability. DESIGN: A food frequency questionnaire was used to assess diet. In a subgroup, this was repeated after 2 years. Questions were asked about major changes to diet over this time. Dietary patterns were identified using principal components analysis and pattern scores were compared at the two time points. The consumption of foods was also examined. The relationship between change in pattern scores and socio-demographic factors and body mass index was assessed. SETTING: The Southampton Women's Survey, a prospective study of diet, health and lifestyle in young women and their influences on fetal growth. SUBJECTS: A subgroup of 94 women from a cohort of 6129 nonpregnant women aged 20-34 years. RESULTS: Two dietary patterns, labelled 'prudent' and 'high energy', were identified. Spearman correlation coefficients between the initial and repeat scores for the prudent and high-energy patterns were 0.81 and 0.64, respectively. Average changes (repeat - initial) were 0.13 and -0.01 SD of initial score. Change in prudent dietary pattern score was influenced by amount of strenuous exercise taken and by changes in partnership status. An increase in high-energy pattern score was associated with lower social class. CONCLUSIONS: Dietary patterns in young women are reasonably stable over a 2-year period. This suggests that dietary patterns identified in the recent past may provide useful information about current dietary patterns.     

Sore throat management in general practice

This paper discusses primary care management of sore throatin the context of recent national ‘consensus’ guidelinesfrom the Drugs and Therapeutics Bulletin. The guidelines advisetaking a throat swab, using typical clinical features whereswabs are not available, and suggest that antibiotics shortenthe duration of symptoms and prevent complications. Systematicreviews and individual studies indicate that the evidence forprescribing antibiotics for most presentations of sore throatin general practice is marginal, and the benefits are probablyoutweighed by the likely costs of antibiotics. Using clinicalscorecards or symptom clusters to identify individuals who wouldbenefit from treatment is insensitive with low predictive value,although inexpensive. Using throat swabs as a gold standardfor diagnosis is inappropriate since they are neither very specificnor sensitive, and will greatly increase costs of management.The relative lack of evidence for the efficacy of antibioticsand for the use of throat swabs from primary care research,and also an unbalanced perspective of dangers and complicationsrelated predominantly to a secondary care setting, underlinesthe problem of achieving valid consensus guidelines. Guidelinesnot firmly based on evidence appropriate to the intended settingare more likely to be received sceptically and hinder gettingresearch into practice. Keywords. Sore throat, clinical guidelines, tonsilitis, pharyngitis, throat swab.     

Effect of Helicobactor pylori eradication therapy on dyspeptic symptoms in primary care

OBJECTIVE: The aim was to explore the effect of eradication therapy ondyspeptic symptoms in patients with known peptic ulcer disease(PUD). METHOD: A total of 164 known dyspeptics and 147 non-dyspeptic attendersat six UK general practices were recruited. The Helisal RapidBlood test was performed in the practices and eradication therapyleft to the preference of the general practitioner. Patientswere followed prospectively by a Likert scaled symptom questionnaireand record review. The symptom questionnaire distinguished betweenpatients known to have dyspepsia and those not. RESULTS: There was a statistically significant decrease in dyspepticsymptoms in patients with known PUD who received eradicationtherapy (n = 43, Z = –2.63, P = 0.009). CONCLUSIONS: Eradication of Helicobacter pylori in primary care can leadto a reduction in consumption of H2 receptor antagonists andhence cost savings. This study demonstrates that dyspeptic symptomsalso decrease. The questionnaire could be used in further studiesto evaluate the effect of management on dyspeptic symptoms inthe primary care setting. Keywords. Dyspepsia, Helicobactor pylori, primary care, therapy, outcome measures.     

Intensity of previous teaching but not diagnostic skills influences stigmatization of patients with substance use disorder by general practice residents. A vignette study among French final-year residents in general practice

Background: High levels of stigma towards patients with substance use disorder (SUD) have been found in health professionals and medical students.

Objectives: To assess the capability of residents in general practice to diagnose SUD correctly; to assess their stigmatization of patients with SUD and to assess the correlation between both variables. We hypothesized a negative correlation.

Methods: In 2014, we conducted a cross-sectional survey among French residents in general practice, using a self-administered questionnaire. First, a clinical case of SUD (tramadol) was presented, to assess the diagnosis and retained diagnostic criteria. A second clinical vignette was presented (intravenous heroin user) to assess stigmatization with the Attitudes to Mental Illness Questionnaire (AMIQ). Its score ranges from –10 (negative attitude) to +10 (positive attitude). AMIQ scores of residents who diagnosed SUD correctly versus incorrectly, and who had received at least six hours versus less than six hours of teaching on this topic, were compared using Student’s t-test.

Results: Of 1284 solicited residents, 303 participated (23.6%), 249 residents diagnosed SUD correctly (82.2%). The mean AMIQ score was –3.91 (SD 2.4) without significant difference regarding the correct diagnosis of SUD; but with a significant difference between residents who had received training in SUD for at least six hours versus residents less trained (AMIQ scores –3.76 (SD 2.46) versus ?4.50 (SD 2.27), p?=?.0354).

Conclusion: Residents in general practice had a good capacity to diagnose SUD correctly but on average expressed negative attitudes toward people with SUD. More SUD teaching seems to help in reducing stigmatizing attitudes.     

Randomized trial of a "talking computer" to improve adults' eating habits

PURPOSE: To assess efficacy of an intervention delivered by an interactive, computer-controlled telephone system to improve individuals' diets. DESIGN: Randomized controlled trial. SETTING: Large multispecialty group practice. SUBJECTS: Two hundred ninety-eight adults who were both sedentary and had suboptimal diet quality. INTERVENTION: Weekly communication for 6 months via a totally automated, computer-based voice system. Among intervention group subjects, the system monitored dietary habits and provided educational feedback, advice, and behavioral counseling. Control group subjects received physical activity promotion counseling. MEASURES: Daily intake of fruits, vegetables, red and processed meats, whole fat dairy foods, and whole grain foods estimated from a food frequency questionnaire. RESULTS: Mean age 45.9 years, 72% women, 45% white, and 45% African-American. Among participants who completed diet assessments, compared with the control group, the intervention raised fruit intake a mean of 1.1 servings per day (95% confidence interval [CI] .4, 1.7). On a 0 to 100 global diet quality score combining all five food groups, intervention participants improved their mean score 9 (95% CI 4, 13) points more than in the control group. The intervention also raised dietary fiber intake 4.0 g/d (95% CI .1, 7.8) and decreased saturated fat, as a proportion of energy intake, by 1.7% (95% CI -2.7, -.7). CONCLUSIONS: This computer-based telecommunications dietary behavior intervention helped improve participants' overall diet.     

A randomized controlled trial of electromagnetic therapy in the primary care management of venous leg ulceration

OBJECTIVE: The aim was to establish the potential efficacy, tolerabilityand side-effect profile of electromagnetic therapy as an adjunctto conventional dressings in the treatment of venous leg ulcers. METHOD: A prospective, randomized, double blind controlled clinicaltrial was carried out in a dedicated leg ulcer clinic basedin one urban general practice. Nineteen patients with leg ulcersof confirmed venous aetiology were assessed. The main outcomemeasures were rate and scale of venous leg ulcer healing, changesin patient-reported pain levels, quality of life, degree ofmobility, side effect profile and acceptability to patientsand staff. RESULTS: Sixty-eight per cent of patients attending this dedicated clinicachieved improvements in the size of their ulcer (4, 21%, healedfully) and in reduced pain levels (P < 0.05) during the trial,despite the chronicity of ulcer histories. Patients treatedwith electromagnetic therapy at 800 Hz were found at day 50to have significantly greater healing (P < 0.05) and paincontrol (P < 0.05) than placebo therapy or treatment with600 Hz. All patients reported improved mobility at the end ofthe study. The electromagnetic therapy was well tolerated bypatients, with no differences between groups in reporting adverseevents, and proved acceptable to staff. CONCLUSION: Despite the small numbers in this pilot study, electromagnetictherapy provided significant gains in the healing of venousleg ulcers and reduction in pain. Keywords. Electromagnetic therapy, RCT, leg ulcers, primary care.     

Childhood vulvovaginitis and vaginal discharge in general practice

OBJECTIVE.: This study aims to examine the aetiology, clinical featuresand response to treatment of childhood vulvovaginitis in generalpractice. METHOD.: A longitudinal survey of consecutive premenarchal patients presentingwith vulvovaginitis and/or vaginal discharge in the course ofnormal consultations with a general practitioner was conductedin a a semi-rural, group general practice with 11 000 patientsin Plymouth, UK. Forty-two premenarchal girls with vaginal inflammationor discharge were surveyed, with main outcome measures beingclinical evaluation, microbiological assessment of urine andvaginal swabs, and patients' and parents' assessments of resolutionand relapse of symptoms. RESULTS.: Non-specific vulvovaginitis with mixed bacterial flora, associatedwith poor hygiene and atrophic vaginal mucosa, was the commonestcause; specific bacteria were found in 10 out of 42 cases, includingsix of Streptococcus pyogenes. No candida was isolated. Treatmentwith topical oestrogen cream was effective only with mixed infection,oral antibiotics were effective in both mixed and single organisms.No evidence of sexual abuse nor foreign body was found. CONCLUSIONS.: Childhood vulvovaginitis is not uncommon in general practice,is usually associated with mixed growth of faecal organisms,and is seldom due to serious causes such as sexual abuse orforeign body. Keywords. Vulvovaginitis, vaginal discharge, children, general practice.     

The effects of a health promotion program on physical, mental, and dietetic health status in climacteric women

PURPOSES: The purpose of this study was to evaluate the effects of a six months health promotion program on physical and mental health status assessments in climacteric women. METHODS: Seventy-two women, with a mean (+/- SD) age of 51.3 (+/- 3.1 yr.), body weight of 51.5 (+/- 6.3 kg), and Body Mass Index of 22.4 (+/- 2.4 kg/m2), residing in Tokyo Metropolitan area, participated as subjects in a health promotion program, completing health status assessments. Health promotion was performed once a week, two hours per session, sixteen times. The lecture and exercise program, in the first half, included basic information on diet, exercise and relaxation, and prevention of life-style related disease, and instructions for walking exercise, dancing, and dumbbell exercise. In the latter half, they performed extended walking, stretching, and autogenic training for relaxation. Healthy foods were also supplied. Before and after the program, health status was assessed, with a general medical health check, a questionnaire regarding nutrition, exercise and relaxation activities, and determination of dietary intake based on food records, eating behavior, complaints (CMI, Nichidai stress score) and physical activity levels. RESULTS: After the six months of the program: 1) Total cholesterol levels had decreased significantly, along with both systolic and diastolic blood pressure, body weight and BMI; 2) Major nutrient intake, density of nutrients and eating behavior were improved, with decrease in daily salt intake, and increase significant in daily energy expenditure; 3) Stress scores by the Nichidai stress check were decreased significantly, subjects with higher stress scores at the beginning of programs having marked change, and neurotic tendencies were decreased in CMI categories II-IV. CONCLUSION: These results suggest that, in order to maintain and/or improve the QOL of climacteric women, good dietary habits and physical activities, such as walking, and psychological support are essential. Further long-term investigations of larger populations (middle-aged to elderly) are now necessary.     

Secular Trends in Dietary Intake over a 20-Year Period in People with Type 2 Diabetes in Japan: A Comparative Study of Two Nationwide Registries; Japan Diabetes Complications Study (JDCS) and Japan Diabetes Clinical Data Management Study (JDDM)

Background: In order to provide effective dietary guidance, it is necessary to consider dietary intake, which can change over time. This study analyzed changes in the diet of Japanese patients with type 2 diabetes over a 20-year period. Methods: We compared the results of two dietary surveys that used the food frequency questionnaire format. The first was conducted in 1996 by the Japan Diabetes Complications Study (JDCS) (n = 1509; males 53.3%), and the second in 2014–2018 by the Japan Diabetes Clinical Data Management Study (JDDM) (n = 1145; males 65.6%). Both are nationwide representative registries of outpatients with type 2 diabetes in Japan. Results: Over a 20-year period, both men and women with type 2 diabetes had a significant increase in body mass index (BMI). Nonetheless, there was only a small change in energy intake. Conversely, there was a significant increase in fat intake and thus in the fat-to-energy ratio. With regard to food groups, there was a significant increase in meat intake and a decrease in the intake of fish, soybeans/soy products, vegetables, and fruits, with a particularly significant decrease in vegetables. Conclusions: Even in Japan, an industrialized country with a stable socioeconomic environment, there were many significant changes in the dietary intake of patients with type 2 diabetes over the 20-year period.     

Effect of health risk appraisal on health outcomes in a university worksite health promotion trial

Data from a 1-year worksite health promotion trial were examinedto assess the effect of a health promotion intervention andhealth risk appraisal (HRA) on health behavior and health statusindicators among university employees. Forty-one departments(N = 2198) were randomly assigned to receive: (1) a health promotionintervention and a HRA, (2) the intervention only, (3) the riskappraisal only or (4) neither. After controlling for age, race,gender, job category and the appropriate baseline measure, groupassignment was used to predict total cholesterol level, systolicand diastolic blood pressure, exercise frequency, and body massindex (BMI) among 801 employees who completed both baselineand follow-up assessment. Receipt of the combination of theintervention and the risk appraisal or each component separatelyresulted in significantly lower systolic blood pressure andBMI.     

The validity of dietary assessment in general practice

OBJECTIVE: To validate a range of dietary assessment instruments in general practice. METHODS: Using a randomised block design, brief assessment instruments and more complex conventional dietary assessment tools were compared with an accepted "relative" standard--a seven day weighed dietary record. The standard was checked using biomarkers, and by performing test-retest reliability in additional subjects (n = 29). OUTCOMES: Agreement with weighed record. Percentage agreement with weighed record, rank correlation from scatter plot, rank correlation from Bland-Altman plot. Reliability of the weighed record. SETTING: Practice nurse treatment room in a single suburban general practice. SUBJECTS: Patients with risk factors for cardiovascular disease (n = 61) or age/sex stratified general population group (n = 50). RESULTS: Brief self completion dietary assessment tools based on food groups caten during a week show reasonable agreement with the relative standard. For % energy from fat and saturated fat, non-starch polysaccharide, grams of fruit and vegetables and starchy foods consumed the range of agreement with the standard was: median % difference -6% to 12%, rank correlation 0.5 to 0.6. This agreement is of a similar order to the reliability of the weighed record, as good as or better than test standard agreement for more time consuming instruments, and compares favourably with research instruments validated in other settings. Under-reporting of energy intake was common (40%) and more likely if subjects were obese (body mass idex (BMI) > or = 30 60% under-reported; BMI < 30 29%, p < 0.001). CONCLUSION: Under-reporting of absolute energy intake is common, particularly among obese patients. Simple self assessment tools based on food groups, designed for practice nurse dietary assessment, show acceptable agreement with a standard, and suggest such tools are sufficiently accurate for clinical work, research, and possibly population dietary monitoring.     

Out-of-hours primary care: development of indicators for prescribing and referring

Background. Dutch general practitioners have reorganized their out-of-hoursprimary health care to general practice cooperatives. Good insightinto the quality of delivered medical care is important to makethe accountability of health practitioners and managers transparentto society and to identify and minimize medical errors. Objective. Development of a set of quality indicators for internal qualityimprovement in out-of-hours primary clinical care. Method. A systematic approach combining the opinion of three differentgeneral practitioner expert panels, and an empirical test indaily practice. The indicators were based on clinical, evidence-based,national guidelines. We tested the validity, feasibility, reliabilityand opportunity for quality improvement. Results. Of the 80 available national clinical guidelines, 29 were approvedand selected by the first general practitioner expert panel.Out of these 29 guidelines, 73 indicators concerning prescribingand referring were selected by the second panel. In an empiricaltest on 36 254 patient contacts, 7344 patient contacts (22.7%)were relevant for the assessment of these 73 indicators. Sixindicators were excluded because they scored more than 15% missingvalues. In total, 38 indicators were excluded because the opportunityfor quality improvement was limited (performance score 90%).In the final meeting, the third general practitioner expertpanel excluded five indicators, leading to a final set of 24indicators. Conclusion. This study shows the importance of subjecting indicators toan empirical test in practice. The national clinical guidelinesare only partially applicable in the assessment of out-of-hoursprimary care. They need to be expanded with topics that arerelated to general practitioner care in an out-of-hours settingand acute medical problems.     

Nutrition advice in primary care: evaluation of practice nurse nutrition training programmes

Primary health care teams (PHCT), including the practice nurse (PN), now have a significant role in health promotion in the UK, which includes the dissemination of advice relating to food and health. However, reports suggest there is a lack of nutritional knowledge among PHCT members and/or problems in communicating dietary advice effectively. Dorset Healthcare Trust employs two full-time primary care dietitians (PCDs). Their remit is to provide training in the field of nutrition to members of the PHCT, primarily PNs, in order to facilitate their role in delivering effective and consistent healthy eating advice. This small research study was designed to evaluate the impact of nutrition training from a primary care dietitian on the attitudes, practice and knowledge of practice nurses. There have been few studies or reports documenting this, which highlighted the need to evaluate the practice nurse training programmes in Dorset. Five practices of varying size were included in the study. Evaluation was undertaken by means of semi-structured interviews with one practice nurse from each practice conducted before and after training. In addition a questionnaire was used as a tool to assess perceived nutrition knowledge and confidence when giving dietary advice. True/false statements and a case history formed part of the questionnaire which was completed both pre- and post-training. Three 1-h training sessions covering the topics of obesity, diabetes mellitus and coronary heart disease were planned. They were presented by the primary care dietitian to each practice nurse together with other members of their PHCT over a 3-month period. The primary care dietitian collected feedback on each training session in order to monitor teaching methods and presentation skills. The study suggests that dietitian-led training sessions are well received by PNs and can have an impact on increasing or updating practice nurses» knowledge about diet, particularly where their initial knowledge was low.