Nicotine chewing gum in general practice: effect of follow up appointments

Two hundred smokers who were judged by their general practitioner to be motivated to stop smoking were allocated to one of two groups. All were offered an initial appointment at which they were advised to stop smoking and offered nicotine gum. One group then received no further appointments. The other was offered four further appointments over three months. Both groups were followed up at six and 12 months. At one year follow up 15.5% overall had stopped smoking, 14% in the low and 17% in the high contact group. This is better than most results so far reported for nicotine chewing gum in general practice, suggesting that general practitioners can use it to good effect. We compare this result with others achieved in general practice.     

Utilization of the "Smokescreen" smoking-cessation programme by general practitioners and their patients

General practitioners have been encouraged to be more active in helping their patients to stop smoking. A number of research studies overseas and in Australia has reported that they can be effective in this form of health promotion. The "Smokescreen" programme is an intensive, structured antismoking intervention that was developed for use by general practitioners in Australia. To monitor the effect of this programme, general practitioners who had attended workshops on the use of the programme were contacted 12 months later to find out what use they had made of the programme, and how effective it had been. Only 18 of the 38 doctors who initially agreed to cooperate in the study had recruited smokers to the programme and had kept records of their progress. These 18 doctors had recruited 121 smokers in the 12-month period: only 7% (approximately) of all their patients who smoked. Of these, 29 (24%) patients reported that they had stopped smoking. Reasons that were given by doctors for their inability to use the programme as fully as they had hoped included the difficulty in recruiting smokers, a lack of time, and a low rate of return by the patients for follow-up visits. These results suggest that while general practitioners should be encouraged to give brief antismoking advice, general practice may not be a suitable location for more-intensive antismoking programmes. Limited health-promotional funds may be deployed better in general community awareness and mass-media programmes.     

A smoking cessation programme for use in general practice

The effectiveness of a smoking intervention programme based in general practice was evaluated at six months by a randomized controlled trial. In the programme, general practitioners achieved a 33% success rate compared with 3% in a control group. Reported abstinence was checked by blood tests for cotinine, carboxyhaemoglobin and thiocyanate. The majority of patients considered that their chances of success were greater if a doctor administered the programme, and that having the results of lung function and blood tests explained in relation to the risks of cardiovascular and respiratory diseases constituted a strong incentive to stop smoking. Two cases illustrating a successful and a failed outcome of the programme are described. If one quarter of general practitioners in Australia adopted this programme in their practice, approximately 150,000 new abstainers could be expected each year.     

A randomized trial of a family physician intervention for smoking cessation

We assessed the impact of three conditions on one-year smoking cessation rates. Physicians in 70 community general practices were randomly allocated by practice to one of three groups: In the usual care group, smoking patients were to receive the care they normally would receive. In the gum only group, physicians were asked to speak to patients about smoking cessation and offer nicotine gum. In the gum plus group, physicians were trained in the experimental intervention. This intervention involved advice to stop smoking, the setting of a quit date, the offer of nicotine gum, and four follow-up visits. Smoking cessation was measured by self-report after one year and validated using saliva cotinine measures. Using a criterion of at least three months of abstinence, 8.8% of the patients of the trained physicians had stopped smoking at the one-year follow-up compared with 4.4% and 6.1% of the patients in the usual care and gum only groups, respectively.     

A smoking cessation intervention program for family physicians.

Family physicians are able to approach many patients who smoke but are often hesitant to help them quit. Lack of knowledge about effective interventions is a major reason for this hesitancy. The important components that have been tested in physician-initiated smoking cessation interventions are advice to quit, information about the risks of smoking and techniques for quitting, nicotine gum, setting a date for quitting and offers of supportive follow-up visits. We describe a cessation program developed for family physicians that incorporates these factors into three types of visits over a 2-month period: the challenge visit, which occurs during a regular office visit and focuses on advice and setting a date to quit; the quit-date visit, which involves instructing patients on the proper use of nicotine gum, if applicable, and confirming their desire to quit; and four supportive follow-up visits, which provide continuing encouragement for 2 months and allow physicians to monitor withdrawal symptoms, relapses and other problems. Such a program can be effectively incorporated into a general practice.     

北京协和医院安宁缓和医疗门诊实践

目的 总结北京协和医院老年医学科门诊接诊安宁缓和医疗病例的情况。方法 回顾性分析2016年1月1日至2019年12月31日在北京协和医院老年医学科门诊N医生处连续接诊患者的门诊资料,记录整理其中85岁以上、恶性肿瘤晚期、非肿瘤性慢性脏器疾病导致功能不全或原发病没有有效治疗方法患者的基本信息、症状、就诊目的和给予的处置。结果 共接诊并记录有缓和医疗需求的患者1388例,其中,男712例(51.3%),平均年龄(69.7±13.5)岁(8~105岁),60岁以上患者占73.3%。其中,63.4%的患者是专门寻求缓和医疗帮助前来就诊,87.2%是因为恶性肿瘤晚期引发的痛苦来就诊。在221例非肿瘤性疾病患者中,衰弱和神经系统退行性疾病是最主要病因。在记录到的5483个症状中,疼痛(21.2%)、纳差(13.1%)、乏力(11.6%)、便秘(6.9%)、失眠(4.6%)、腹胀(4.6%)是最常见的6个症状。在共计2502例次的就诊中,26.2%患者为多次就诊;在多次就诊的患者中,50.3%患者就诊次数大于等于3次。患者本人来就诊的比例为38.6%,65.7%的就诊是2位及以上家人(包括患者)参与。就诊时长平均为(19.6±8.5)min(2~85 min),其中,10 min以内、11~20 min、21~30 min和超过30 min结束诊疗的比例分别为13.5%、53.0%、25.6%和7.9%。结论 在北京协和医院老年医学科门诊患者中,有缓和医疗需求的患者比例很高。在老年医学科门诊提供安宁缓和医疗服务是可行的。     

Outcome of Treatment of Alcohol Dependence Syndrome Patients in Military Psychiatry Set Up

Background

Many people believe that patients suffering from Alcohol Dependence Syndrome do not respond much to treatment. Such belief may adversely affect the treatment of these patients. This may also alter the attitude of administrators on disposal of these patients. In this study, an attempt was made to observe the treatment outcome of patients suffering from Alcohol Dependence Syndrome.

Method

Medical documents of all patients suffering from Alcohol Dependence Syndrome who reported for follow up in a general hospital psychiatric centre during the period of 1995-2000, were scrutinized. Patients were divided into three categories - those who were in relapse, those who improved partially and those who maintained abstinence.

Results

Out of 341 cases, 146 patients were reviewed after six months, 57 after one year, 50 after one and half years and 88 were reviewed at 2 years and above. When a total was made about the number of relapses, partial improvement and abstinent cases, it was found that 33.16% had relapses, 35.49% cases showed partial improvement and 31.35% cases were abstinent.

Conclusion

The result was contrary to a prevailing belief that these patients do not respond much to treatment. It showed that two third of the patients improved, out of which one third were abstinent at the time of review. This study is likely to encourage the doctors, patients and administrative authorities to seek treatment of patients suffering from Alcohol Dependence Syndrome as treatment definitely helps many of them.Key Words: Abstinence, Alcohol Dependence Syndrome, Relapse     

Value of routine follow up of women treated for early carcinoma of the breast

The value of routine follow up of women treated for early breast cancer by mastectomy with or without postoperative radiotherapy was assessed retrospectively. Over eight years 546 patients made 6863 clinic visits, during which 192 first relapses were detected. Ninety three relapses were detected at scheduled (routine) visits and 99 at unscheduled (interval) visits. First relapses within the treated area or in the contralateral breast were detected significantly more commonly at routine visits than were first metastatic relapses (66/89 (74%) compared with 27/103 (26%)). Patients whose local relapse was detected at a routine visit had a significantly better survival than those whose local relapse was detected at an interval visit. A relapse that was potentially curable (local or in the contralateral breast) was detected at 66 (1%) of 6764 routine visits, but only 26 (39%) of these patients remained free of disease. It is concluded that the intensity of follow up of such patients could be reduced without any adverse effect on prognosis but with appreciable financial and other benefits.     

Five-year follow up for sobriety in a cohort of men who had attended an Alcoholics Anonymous programme in India

BACKGROUND: There are little data from India on the long term follow up of patients with alcohol dependence who have undergone a de-addiction programme. A cohort of patients who completed a detoxification and de-addiction programme based on the Alcoholics Anonymous model were followed up for a period of 5 years. METHODS: A cohort design was used. A community outreach programme of a de-addiction centre was the setting for the study. One hundred and eighty-two patients who completed a detoxification and de-addiction programme based on the Alcoholics Anonymous model were followed up. Sobriety at 5 years' of follow up was the outcome measure. RESULTS: One hundred and fifty-one (83%) patients were followed up at 5 years. The majority (90; 59.6%) did not change their alcohol consumption and a small minority (25; 16.5%) remained completely sober over the 5-year period. Sobriety at 1 year was significantly associated with complete abstinence at 5 years (chi2 = 53.8; df = 1; p < 0.001). More patients coming from distant places (RR 0.84; 95% CI: 0.71, 0.98; p < 0.03) and those with health workers in their localities (RR 0.81; 95% CI: 0.68, 0.96; p < 0.01) were completely abstinent. These variables were also significantly associated with sobriety even after adjusting for other confounders using logistic regression. CONCLUSION:. The results of the 5-year outcome are modest. More patients coming from distant places and those with health workers in their localities remained completely abstinent suggesting the possible role of the individual's motivation and the need for continued community support in maintaining sobriety.     

What happens to opiate addicts immediately after treatment: a prospective follow up study

In the first British study to investigate systematically what happens to opiate addicts after treatment 50 opiate addicts admitted for inpatient treatment of their drug dependence were followed up for six months after discharge. All had been withdrawn from opiates before follow up. Six months later 26 were not using opiates: 12 had not used opiates at any time since discharge. When subjects in hospital or in prison were excluded from the analysis 21 (47%) of the subjects living in the community were not taking opiates. Many subjects used opiates within days of leaving the inpatient unit, but this first lapse did not necessarily lead to a full relapse into addictive use. During the six months after discharge several subjects used opiates on a less than daily basis. During each two month period throughout the six months of follow up the proportion of subjects who were occasional users fell, the proportion of abstinent subjects grew, and the proportion of daily users (assumed to be readdicted) remained constant. Although many of the addicts relapsed soon after treatment, it was encouraging that almost half were opiate free after six months. These results have important implications for the treatment of drug addicts.     

Uroflowmetry before and after transurethral resection of prostate for bladder outlet obstruction

This prospective study evaluates the effectiveness of uroflowmetry to follow up the patients of benign prostatic hyperplasia treated by transurethral resection of prostate. Total sixty eight patients of 50 to 70 years age group attending for the treatment of BPH with bladder outlet obstruction in the department of Urology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka were recruited for the study. All the TURP's were performed by experienced urologist. Patients were advised to come after 3 months and 6 months for follow up visits. In each visit, the patients were evaluated through history, physical examination and relevant investigations including IPSS and uroflowmetry. Significant improvement was observed in term of Qmax, voided volume, and voiding time in all patients after TURP. Mean (+/-SD) IPSS change in pre to post TURP was 16.2(+/-0.76) (p<0.05). The objective parameters of uroflowmetry correlated well with the subjective parameters represented by IPSS in this study.     

Evaluation of screening for hypertension in general practice with an automatic machine

An automatic device for measuring blood pressure was used to screen all patients aged 30 to 65 years registered at a health centre. Of those who were eligible, 55% attended. Patients with previously recognised hypertension were more common among the attenders than among the non-attenders. High readings obtained on the automatic device possibly deterred some patients from reattending for follow up measurements of blood pressure. Although the device is quick and easy to use, the logistic challenge of formal blood pressure screening is considerable. Hypertension was discovered in 52 patients (mean diastolic pressure greater than 100 mm Hg). Retrospective analysis of their medical records showed that a third had had an abnormal blood pressure reading noted during the past 10 years and no further action had been taken, and almost three quarters had attended their practitioner during the previous year without having a blood pressure measurement recorded. One year after the screening procedure two fifths of the newly discovered hypertensive patients had defaulted from follow up and treatment. Automatic devices are not a short cut to the discovery of occult hypertension. Case finding by routine measurement of blood pressure at surgery visits is more efficient.     

新型农村合作医疗对轻度慢性阻塞性肺疾病患者管理效果评价

目的评价新型农村合作医疗管理轻度慢性阻塞性肺疾病（COPD）患者的效果。方法2008年1月至2010年12月,采用准实验设计方法,以山东省海阳市东村和方圆两个办事处区域内的轻度COPD患者为研究对象。东村辖区COPD患者61例（管理组）接受3年新型农村合作医疗系统管理,管理内容包括戒烟宣传、脱离有害环境、使用流行性感冒疫苗、知识教育等。方圆辖区60例COPD患者作为对照组。结果管理3年后随访,管理组管理前与管理2年和3年后比较,BODE指数（字母所示依次为体重指数、气流阻塞、呼吸困难、运动能力）下降值均大于对照组同期（P〈0．01）;管理3年后患者年均感冒次数、急性加重次数、因COPD就诊次数明显低于自身管理前和对照组同期（P〈0．05）。在肺功能方面,两组管理前和3年后比较第一秒用力呼气容积、第一秒用力呼气容积／用力肺活量均有不同程度下降（P〈0．05）,但二者变化不大（P〉0．05）。结论利用新型农村合作医疗体系对COPD患者进行管理,可以减少COPD的急性发作和就诊次数,提高生存质量。     

戒烟对糖尿病合并冠心病患者冠脉支架植入术后预后的影响

目的观察2型糖尿病合并冠心病患者行冠脉成形及支架植入术后是否戒烟对支架内再狭窄及预后的影响。方法观察2001年5月至2003年5月我院收治的糖尿病合并冠心病同时吸烟的患者行冠脉成形及支架植入术后的患者,共179例按术后是否完全戒烟分为戒烟组共106人;非戒烟组73例。术后常规随访6个月,观察指标包括死亡等心血管事件等,6个月后行活动平板检查,结果阳性的行再次选择性冠脉造影。如因各种原因不能行活动平板检查,直接行冠脉造影。结果随访期间无死亡病例,非戒烟组23例(21.7%)冠脉造影证实支架内再狭窄,而戒烟组仅14例(13.6%)冠脉造影证实支架内再狭窄。两组再狭窄例数比差异有显著性(P=0.004)。结论2型糖尿病合并冠心病行冠脉成形及支架植入术患者,如术前有吸烟史,术后戒烟能有效减少此类患者的支架内再狭窄。     

Trial of relaxation in reducing coronary risk: four year follow up

On screening 192 men and women aged 35-64 were identified as having two or more of the following risk factors: blood pressure greater than or equal to 140/90 mm Hg, plasma cholesterol concentration greater than or equal to 6.3 mmol/l (243.6 mg/100 ml), and current smoking habit greater than or equal to 10 cigarettes a day. They were randomly allocated to a group for modification of behaviour or to serve as controls. Both groups were given health education leaflets containing advice to stop smoking, to reduce animal fats in the diet, and on the importance of reducing blood pressure. In addition, the treatment group had group sessions of one hour a week for eight weeks in which they were taught breathing exercises, relaxation, and meditation and about managing stress. It had previously been found that after eight weeks and eight months there was a significantly greater reduction in both systolic and diastolic blood pressures in the group taught to relax compared with the control group. After four years of follow up these differences in blood pressure were maintained. Plasma cholesterol concentration and the number of cigarettes smoked were lower in the treatment group at eight weeks and eight months but not at the four year follow up. At four years more subjects in the control group reported having had angina and treatment for hypertension and its complications. Incidence of ischaemic heart disease, fatal myocardial infarction, or electrocardiographic evidence of ischaemia was significantly greater in the control group. If the results of this study could be obtained in a larger study the financial and health care implications would be enormous.     

天芪平颤方治疗帕金森病运动症状临床观察

目的:观察天芪平颤方化裁结合西药治疗帕金森(PD)的临床疗效。方法:98例患者随机分为验证组(49例)、对照组(49例),两组均常规服用西药,验证组加裁本方(服药3个月—停药1个月—服药3个月),共随访7个月,评估治疗前后UPDRS(I、II、III)评分、PIMS评分、中医证候等参数变化。结果:7个月随访时验证组UPDRS评分有改善,验证组用药后对运动症状的改善幅度较对照组优(P0.05);PIMS评分,中医证候积分均有明显改善(P0.05);7个月随访时,2组多巴等效剂量都有增加,但验证组左旋多巴等效剂量的升高明显低于对照组(P0.05)。结论:天芪平颤方对PD运动症状有协助改善作用;天芪平颤方对PD运动患者生活质量有较好改善作用。     

Ablative radioiodine therapy for hyperthyroidism: long term follow up study

A total of 225 patients were treated for hyperthyroidism with 555 MBq (15 mCi) radioiodine to ablate the thyroid and induce early hypothyroidism. The efficacy of this treatment in eradicating hyperthyroidism and problems of follow up were assessed one to six years later from case records and questionnaires. Information was received from 197 out of 219 live patients (90%) and from 160 doctors concerning 207 patients (92%). Only three patients were not traced and six had died since treatment. The modal time to hypothyroidism was three months, and 64% of patients were hypothyroid at one year; 5.6% had failed to become euthyroid within one year. Ninety five per cent of patients had been seen by the doctor and 82% had had a thyroid test done within the past two years. Most doctors preferred patients to be returned to their care once thyroxine treatment was stabilised. An ablative dose of 131I is recommended as an effective means of treatment which has clear advantages over conventional methods. Good communications and effective follow up should ensure success.     

高血压会员制在农村高血压管理中的应用

目的：观察高血压会员制在农村高血压管理中的作用。方法：对陕西省泾阳县周边农村7000余名高血压患者实行会员制管理，通过开展健康讲座、复诊、随访等方式，评估危险因素、建立健康的生活方式、干预并指导用药。结果：通过会员制管理，良好控制患者血压，普及高血压相关知识，使高血压的知晓率、治疗率、控制率明显提高。结论：对农村高血压患者采用会员制管理是切实有效的措施。