What do family medicine trainees say about their training?

Objective: To survey the vocational trainees' evaluation of their training. Design: Questionnaire survey with quantitative and qualitative components. Setting: All trainees, past and present, registered with the Hong Kong College of Family Physicians up to April 2002. Main outcome measure: Quantitative analysis on trainees' agreement/disagreement on specific items of their training, and qualitative analysis of themes extracted from all the responses to open-ended questions. Results: 247 out of 355 present and past trainees responded. Overall, the trainees found the training useful and they learnt the knowledge and skill of family medicine. The Basic Hospital Trainees were more likely to have dissatisfaction than the other trainees; they perceived low esteem, were engaged more in service than in training, and were uncertain about what they were expected to learn. The Basic Community Trainees had diverse and balanced opinions on their training and were more concerned with the variable quality of supervision. The Higher Trainees would like to have a more structured and organised training program than the present one. The trainees suggested that the College of Family Physicians could do more to assure quality of training and to facilitate more communication among the trainers, trainees and the College. Conclusion: The trainees have given a lot of useful and constructive information about their training.published_or_final_versio

Feasibility, acceptability and utility of an e-cardiovascular risk platform among physicians and patients in the primary care setting

Poster Session 1: Other Themes: P1-542link_to_OA_fulltextIEA World Congress of Epidemiology, Edinburgh, Scotland, United Kingdom, 7-11 August 2011. In Journal of Epidemiology & Community Health, 2011, v. 65 n. Suppl. 1, p. A216-A217, abstract no. P1-54

Implication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival: A Planned Subanalysis of the ENIGMA-II Trial.

BACKGROUND: Globally, >300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery. METHODS: We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk. The primary outcome was mortality within 1 postoperative year. We defined 4 separate types of postoperative adverse events. Major adverse cardiac events (MACEs) included myocardial infarction (MI), cardiac arrest, and myocardial revascularization with or without troponin elevation. MI was defined using the third Universal Definition and was blindly adjudicated. A second cohort consisted of patients with isolated troponin increases who did not meet the definition for MI. We also considered a cohort of patients who experienced major adverse postoperative events (MAPEs), including unplanned admission to intensive care, prolonged mechanical ventilation, wound infection, pulmonary embolism, and stroke. From this cohort, we identified a group without troponin elevation and another with troponin elevation that was not judged to be an MI. Multivariable Cox proportional hazard models for death at 1 year and assessments of proportionality of hazard functions were performed and expressed as an adjusted hazard ratio (aHR) and 95% confidence intervals (CIs). RESULTS: MACEs were observed in 469 patients, and another 754 patients had isolated troponin increases. MAPEs were observed in 631 patients. Compared with control patients, patients with a MACE were at increased risk of mortality (aHR, 3.36 [95% CI, 2.55-4.46]), similar to patients who suffered a MAPE without troponin elevation (n = 501) (aHR, 2.98 [95% CI, 2.26-3.92]). Patients who suffered a MAPE with troponin elevation but without MI had the highest risk of death (n = 116) (aHR, 4.29 [95% CI, 2.89-6.36]). These 4 types of adverse events similarly affected 1-year disability-free survival. CONCLUSIONS: MACEs and MAPEs occur at similar frequencies and affect survival to a similar degree. All 3 types of postoperative troponin elevation in this analysis were associated, to varying degrees, with increased risk of death and disability