Family physician access to specialist advice by telephone: Reduction in unnecessary specialist consultations and emergency department visits.

PROBLEM ADDRESSED: Timely access to specialist care is an important issue for patients with mild to moderate symptoms, and wait times for referrals are currently quite long. OBJECTIVE OF PROGRAM: To provide FPs with quick telephone access to other specialists for treatment advice for patients with nonserious conditions that they would otherwise refer to specialist care. PROGRAM DESCRIPTION: The RACE (Rapid Access to Consultative Expertise) program is a telephone hot-line providing FPs and nurse practitioners in the Vancouver, BC, area with timely access to specialist consultations. An evaluation of data from RACE found 60% of RACE calls prevented patients from visiting a specialist and 32% of calls prevented FP referrals to hospital emergency departments. CONCLUSION: Supported by RACE, FPs can more effectively remain the locus of patient care, calling on other specialist expertise when appropriate and providing better coordination of care for their patients. Evaluations to date suggest RACE helps reduce system costs by reducing unnecessary emergency department visits and face-to-face specialist consultations.

An innovative academic-practice partnership to enhance the development and training of military nurses.

Academic-practice partnerships have been identified by the American Association of Colleges of Nursing as a best practice for advancing the profession of nursing in a collaborative manner by sharing goals, knowledge, and respect in a mutually beneficial line of effort. Training military nurses poses a unique challenge to academia and military nurse corps to produce competent nursing professionals who are also effective military officers. The academic-practice partnership between the United States Army Cadet Command's ROTC program and the University of San Francisco's School of Nursing is a prime example of such a partnership. Through the innovative month-long nurse summer training internship program, Army nursing students work one-on-one with an experienced Army nurse preceptor to receive an intense clinical experience with a minimum of 150 h of hands-on patient care in a military medical treatment facility. This example of cognitive apprenticeship learning provides an adjunct to nursing program curricula in addition to an introduction of the roles and responsibilities of a military officer. This academic-practice partnership helps develop a strong group of novice nurses who are confident leaders and critical thinkers that easily make the transition from academia to professional practice.

Dietary measures and exercise training contribute to improvement of endothelial function and atherosclerosis even in patients given intensive pharmacologic therapy.

PURPOSE: Atherosclerosis contributes to cardiovascular mortality and morbidity even with aggressive lipid management. Our objective is to determine whether a combined pharmacological and lifestyle intervention can improve atherosclerosis. METHODS: We conducted a 2-year observational study at a specialized clinic in a tertiary care hospital. One hundred fifty-six subjects with coronary disease were enrolled in an intensive pharmacological management and lifestyle measures (including counseling and exercise training) program designed to reach specific targets. The main outcome measures were carotid intima media thickness and plaque area; brachial artery flow-mediated dilation; nitroglycerin-mediated dilation; flow-mediated dilation-nitroglycerin-mediated dilation ratio; laboratory parameters including lipids, glucose, creatinine, and homocysteine; and physical fitness. RESULTS: At completion, there were improvements in lipids and physical fitness. There were no overall changes in flow-mediated dilation, nitroglycerin-mediated dilation, or carotid intima media thickness in the entire cohort. However, multivariate logistic regression showed that dietary and exercise variables, such as increasing fiber intake and reducing body weight and body fat percentage, were independent predictors of improvements in endothelial function and carotid plaque burden. CONCLUSIONS: Even in the setting of intensive pharmacological therapy, lifestyle interventions, including exercise training and dietary changes, are important determinants of improved endothelial function and atherosclerosis.