Biomedical subjects

L Cicutto

Publications and source records attributed to L Cicutto.

4 recordsLinked to original sources

PubMed2000

Implementing continuing education strategies for family physicians to enhance asthma patients' quality of life.

The goal of the study was to provide asthma-related continuing medical education (CME) to family physicians with the objective of improving patient outcomes. Using a quasi-experimental design in a single community, the intervention included academic detailing, a case-based workshop, newsletters, medical grand rounds, and patient-centered education materials. Outcome measures included physician participation in CME; patient self-reported quality of life, asthma knowledge, asthma self-management, medication use, and health service utilization before and after the intervention; and physician feedback. Our results indicated that 78% of family physicians participated in one or more of the CME activities. The majority of physicians provided positive feedback on the use of the intervention both from their own and their patients' perspectives. Academic detailing increased the involvement of physicians in CME. We concluded that there was a statistically significant improvement in patients' quality of life, whereas changes in patients' knowledge, behavior, and health service use were positive but not statistically significant. Methodological factors are identified that could improve the effectiveness of future studies.

Adolescent↗

PubMed1989

Nocturnal asthma therapy. Inhaled bitolterol versus sustained-release theophylline.

Many asthmatics complain of increased symptoms, awakenings, and need for additional medications during the sleeping hours. Sustained-release theophylline (THEO) may be superior to conventional inhaled bronchodilators in preventing nocturnal asthma symptoms and the early morning decrement in lung function common to this population. However, recent studies have demonstrated that THEO may delay sleep onset and perturb sleep stage distribution. No previous study has evaluated electroencephalographic, cardiac, and gas exchange indices during sleep in asthmatics treated with THEO compared with a long-acting inhaled beta 2-agonist. The study goals were to determine if theophylline perturbed sleep when compared with beta 2-agonists and to determine which agent achieved best control of daytime and nocturnal pulmonary symptoms and lung dysfunction. We evaluated 26 subjects with mild to moderate asthma and a history of frequent nocturnal symptoms who previously demonstrated decrements in AM lung function. THEO was compared with 3 puffs every 8 h (6 A.M., 2 P.M., and 10 P.M.) of bitolterol (BITOL), a long-acting beta 2-agonist, in a randomized, double-blind, placebo-controlled cross-over study. Each drug was administered for a 2-wk period ending with two consecutive nights of sleep evaluation followed by cross-over to the alternate drug regimen. During THEO administration, plasma concentrations on awakening were 11.4 +/- 0.69 micrograms/ml as compared with 0.00 micrograms/ml during BITOL. THEO was not found to disrupt sleep as sleep latency, total sleep time, percentage of total sleep time spent in Stages 1, 2, and 3/4 and in REM sleep were similar during each regimen.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗

PubMedDate not supplied

Physician asthma management practices in Canada.

OBJECTIVES: To establish national baseline information on asthma management practices of physicians, to compare the reported practices with the Canadian Consensus recommendations and to identify results potentially useful for interventions that improve physician asthma management practices. DESIGN: National, stratified cross-sectional survey. SETTINGS: The 10 provinces and two territories of Canada, from 1996 to 1997. PARTICIPANTS: Questionnaires were sent to 4489 physicians stratified by province/territory and specialty group (family/general practice, respirology, internal medicine, pediatrics and allergy/immunology); 2605 responses were received. OUTCOME MEASURES: Methods for the diagnosis, treatment, education and follow-up of patients with asthma ('asthma management practices'). RESULTS: Significant variations existed among the five specialty groups in asthma management practices. A low use of objective measures of airflow limitation to assist with diagnosis was found among some respondents (mostly family physicians). Up to 40% of physicians regarded the daily fixed dosing (three or four times a day) of inhaled, short acting beta2-agonist as 'first-line therapy' for moderate to severe asthma. A minority of physicians reported using written action plans for patients or referring them to other health professionals for asthma education. Insufficient time during appointments and a perceived lack of appropriate educational materials were frequently cited as reasons for not providing asthma education. The perceived knowledge of the Canadian Consensus recommendations varied among physicians but was lowest among nonspecialists. CONCLUSIONS: The survey showed variations in certain aspects of the management of asthma by physicians. The findings will help to target specific areas for future physician education programs and other behavioural change strategies.

Asthma↗

PubMedDate not supplied

Asthma education and management programs in Canada.

OBJECTIVE: To establish the number and type of asthma patient education programs throughout Canada. DESIGN: National survey. SETTING: Canada. METHODS: Over a three-year period, contact was made with individuals and groups offering educational services for patients with asthma. Education given as part of a physician's consultation or a pharmacist's dispensing of medications for asthma was not considered a patient education program for the purposes of the survey. Contact was initially established by asking staff from well known asthma programs to provide lists of other such programs in their provinces or regions. Asthma programs were also identified from notices presented at Canada's Third and Fourth National Conferences on Asthma and Education. Lung associations, lay organizations and industry representatives affiliated with the Canadian Network for Asthma Care helped to supplement the list. Once identified, each patient education program was contacted by telephone and by mail to complete a 26-item questionnaire about their program. The province of Quebec was not included in the survey because it already had a province-wide, structured asthma education program and register. RESULTS: Seventy-four asthma education and management programs were identified outside Quebec. Staff in these programs were registered nurses (n=46), respiratory therapists (n=48) and other health professionals (n=21). Forty-one programs stated that at least one member of their staff had been trained as an asthma educator. In 71 programs, the initial patient encounter was of at least one hour's duration. Physician referral was required by 41 programs. The province of Quebec has a joint asthma education program provided by 114 asthma education centres throughout the province under the umbrella of the Quebec Asthma Education Network (QAEN). This comprehensive program is provided in hospitals and community centres by specialized educators - nurses, pharmacists or respiratory therapists - to patients referred by their physicians. CONCLUSIONS: A three-year search for asthma education programs in Canada identified 74 patient education programs (outside Quebec) for an asthma population estimated to exceed 1.2 million. For the province of Quebec, an integrated asthma education program is provided through a network of 114 education centres - the QAEN. The present survey shows that there has been progress in establishing asthma education programs in Canada, although there are significant regional differences in the availability of such programs.

Adult↗