The impact on medical practice of commitments to change following CME lectures: a randomized controlled trial.

BACKGROUND: Self-reported commitment to change (CTC) could be a potentially valuable method to address the need for continuing medical education (CME) to demonstrate clinical outcomes. AIM: This study determines: (1) are clinicians who make CTCs more likely to report changes in their medical practices and (2) do these changes persist over time? METHODS: Intervention participants (N = 80) selected up to three commitments from a predefined list following the lecture, while control participants (N = 64) generated up to three commitments at 7 days post-lecture. At 7 and 30 days post-lecture, participants were queried if any practice change occurred as a result of attending the lecture. RESULTS: About 91% of the intervention group reported practice changes consistent with their commitments at 7 days. Only 32% in the control group reported changes (z = 7.32, p < 0.001). At 30 days, more participants in the intervention group relative to the control group reported change (58% vs. 22%, z = 3.74, p < 0.01). Once a participant from either group made a commitment, there were no differences in reported changes (63% vs. 67%, z = <0.00, p = 0.38). CONCLUSION: Integration of CTC is an effective method of reinforcing learning and measuring outcomes.

Nutritional assessment and counseling for prevention and treatment of cardiovascular disease.

Physicians face several barriers to counseling their patients about nutrition, including conflicting evidence of the benefit of counseling, limited training and understanding of the topic, and imperfect and varied guidelines to follow. Because cardiovascular disease remains the leading cause of death in industrialized nations, family physicians should provide more than pharmacologic interventions. They must identify the patient's dietary habits and attitudes and provide appropriate counseling. Tools are available to help, and a seven-step approach to nutritional therapy for the dyslipidemic patient may be useful. These steps include recommending increased intake of plant proteins; increased intake of omega-3 fatty acids; modification of the types of oils used in food preparation; decreased intake of saturated and trans-fatty acids; increased intake of whole grains and dietary fiber (especially soluble fiber) and decreased intake of refined grains; modification of alcohol intake, if needed; and regular exercise. Recommendations should be accompanied by patient information handouts presenting acceptable substitutions for currently identified detrimental food choices.

Approaching the suicidal patient.

The suicide of a patient can be devastating to the family and to the family physician. The patient's death may shake the physician's confidence, undermine any willingness to work with patients with a mental illness, and provoke professional and legal review. In an attempt to help the family physician prevent suicide, this article reviews known risk factors and offers a strategy for assessing these factors in individual patients. The authors outline interventions that fit the existing level of risk and provide suggestions for the physician in the event of a completed suicide.