Improved cardiovascular prevention using best CME practices: a randomized trial.

INTRODUCTION: It was hypothesized that after a continuing medical education (CME) event, practice enablers and reinforcers addressing main clinical barriers to preventive care would be more effective in improving general practitioners' (GPs) adherence to cardiovascular guidelines than a CME event only. METHODS: A cluster-randomized trial was conducted on a convenience sample of 122 GPs who were randomly assigned to either CME only (control group) or CME with practice enablers and reinforcers (PER group). In the PER group, nurses visited GPs' offices once a month to implement the clinical intervention on patients > or = 55 years old with a scheduled visit in the month following the nurse visit: (1) screening medical records for potentially undermanaged high-risk patients; (2) prompting physicians to reassess preventive care in these patients; (3) enclosing a checklist reporting most recent information relevant to guidelines' implementation; and (4) enclosing a summary of experts' recommendations in the form of a follow-up and treatment algorithm. RESULTS: A retrospective chart audit of 2344 consenting patients, potentially undermanaged at baseline, demonstrated that the PER intervention following CME significantly improved adherence to guidelines compared to CME alone (OR: 1.78, 95% CI: 1.32-2.41). DISCUSSION: The intervention was designed for self-implementation in primary care practices that have their own nursing staff. PER GPs were highly satisfied with the intervention; the majority said that they would implement it in their practice if someone trained their nurse, thus suggesting support for development of a multiprofessional CME program to disseminate this clinical approach to primary care practice groups.

Perception of the social support for adolescents who undergo corrective back surgery for scoliosis.

The objective of this study is to compare the perception of social support upon admission and 6 weeks postoperation of adolescents aged 13 to 19 years (M = 14.7 years), who underwent corrective back surgery for scoliosis. Twenty-two French-speaking participants were found from three different hospital centers located in two large cities in the Quebec province. Data were collected using the French version of Interpersonal Relationships Inventory (IPRI). No significant difference was observed between the results obtained on admission and those obtained 6 weeks later for the global measures of social support available. Nevertheless, analysis of data at the two time points showed a significant difference with regard to intimacy of adolescents. Adolescents reported feeling more invaded in the postoperative period (6 weeks after the surgery) than on admission at the hospital. These results serve to point out the nursing care involvement as well as the surgical techniques and ambulatory care that reduce hospitalization time. The results raise questions about the nurse's role in the adequate support for adolescents as well as the impact of reduced length of hospitalization.

Intraoperative tracking of the trunk during posterior instrumentation of the scoliotic spine: a feasibility study.

Scoliosis involves spine and trunk deformities. However, during posterior instrumentation of the scoliotic spine, only the exposed spine is currently seen or tracked using navigation systems. A technique for intraoperative tracking of the trunk was developed in order to optimize the surgical correction of the scoliotic trunk deformity. The feasibility of this technique was assessed by comparing the trunk geometry between 19 normal and 21 scoliotic subjects, using an experimental set-up simulating the position adopted during posterior scoliosis surgery. Eleven magnetic sensors placed on anatomical landmarks of the trunk were used to compute nine geometric indices. The geometric indices were closer to zero for normal subjects. Therefore, indices approaching zero during the surgical manoeuvres would indicate a reduction of the trunk asymmetry. Only three of the nine indices were significantly different between normal and scoliotic subjects. This result indicates that the positioning of the subjects on the Relton-Hall frame tends to "normalize" the trunk geometry since the standing position gives more significant differences between normal and scoliotic subjects. The real-time quantification of the trunk geometry during surgical correction of scoliosis may allow the surgeon to improve the correction of both spinal and trunk deformities or to optimize the positioning of the patients on the operating table.