Summary
Impaired physical capacity is common in people with severe levels of obesity. We aimed to investigate changes in physical capacity outcomes in patients with severe obesity following 12 months of physician‐led multidisciplinary care from a “real world” Australian public hospital setting using a case series study design. We extracted data from medical records for all of the eligible patients referred to our clinical obesity service from 2010 to 2015 (69 of 239). We found significant (P < .05) pre‐test/post‐test (mean ± SD) improvements in the 6‐minute walk test (6MWT) (339 ± 120 to 417 ± 112 m); 30‐second sit‐to‐stand test (11 ± 4 to 15 ± 6 counts) and sit‐and‐reach test (−12 ± 13 to −8 ± 15 cm). Using linear mixed‐effects models adjusting for repeated measurements over time (baseline vs 12 months) and testing for potential predictors, we found: mean 6MWT was associated with 12‐month time period (56 m), body mass index (BMI, −3 m), no walking aid over 12 months (106 m) and no opioid analgesics (75 m); mean sit‐to‐stand was associated with 12‐month time period (3 counts), age at referral (−0.2 counts), BMI (−0.2 counts), and diabetes (3 counts); and mean sit‐and‐reach was associated with 12‐month time period (5 cm), female gender (5 cm) and total medications (−0.9 cm). Using causal mediation analysis, our results show that total exercise classes partially mediates change in walking capacity among those with cardiovascular disease. Our study shows that significant and clinically important improvements in physical capacity outcomes in patients with severe obesity can be achieved following 12 months of intensive specialist obesity services, such as ours.
Background
Training in medicine is highly demanding and coincides with critical life tasks including relationship development, childbearing and rearing. The rigid requirements of training programmes risk precluding successful achievement of these extracurricular roles, forcing choices between work and other life commitments. Flexible employment structures that facilitate the development of high‐quality physicians are needed.
Aim
To assess the outcomes of 2 novel flexible training positions in Rheumatology.
Methods
The clinical department, trainees and senior administration designed flexible, part‐time advanced training positions in rheumatology. We sought to deliver excellent training, supervision and support while ensuring safe, efficient clinical service delivery within existing systems and cultures. Barriers to implementation were actively identified. We rejected job share arrangements in favour of independent part‐time positions anchored to departmental education, clinical and trainee needs. The outcomes of these positions have been determined through regular trainee meetings, clinic activity and costs.
Results
Trainees achieved all training requirements, reported high levels of job satisfaction, strong professional development, improved work−life balance and reduction of stress. Outpatient events increased and waiting times have decreased. We estimate that increased rebatable outpatient services have rendered the positions cost neutral.
Conclusion
Flexible training positions can enhance clinical departments while enabling high‐quality training for junior doctors. Further work should consider longer term outcomes and application to different clinical and training settings.
Poster Tours (PT) / Resuscitation 155 (2020) S22-S42 Methods: Retrospective analysis of the registry of the cardiac arrests in the capital city of the Czech Republic, which were dealt with by Prague Emergency Medical Services (EMS) during COVID-19 outbreak period (March and April 2020), compared to the same period of the year 2019. All EMS-resuscitated patients with pre-EMS-arrival out-of-hospital cardiac arrest (CA) were included.Results: During the study periods, Prague EMS dealt with 74 CA in 2019 compared to 75 CA in 2020, respectively. In 2019, Lay CPR was provided in 63 cases (85%), in 2020 in 65 cases (86%); p > 0.05. Mouth-to-mouth ventilation was provided in 4 cases in 2019 and 3 cases in 2020 (p > 0.05). Primary outcome (return of spontaneous circulation in the out-of-hospital environment) was achieved in 37 (2019) vs. 32 (2020) cases (p > 0.05). We were also not informed about any case of non-willingness to provide layperson CPR, as happened in Australia. 3 Conclusion: Willingness of lay people in the city of Prague to provide CPR was not affected by the pandemic situation in general. The primary outcome was also not affected. Despite the fact that reasons for this were not surveyed, the effect of telephone assisted CPR is playing a crucial role during the last decades. 4
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