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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 in adolescents: a randomized, controlled trial of an asthma program for adolescents and young adults with severe asthma.

BACKGROUND: Asthma is common and is often poorly controlled in adolescent subjects. OBJECTIVE: To determine the impact of an age-specific asthma program on asthma control, particularly on exacerbations of asthma requiring emergency department treatment, and on the quality of life of adolescents with asthma. METHODS: The present randomized, controlled trial included patients who were 15 to 20 years of age and had visited emergency departments for management of their asthma. The interventional group attended an age-specific asthma program that included assessment, education and management by a team of asthma educators, respiratory therapists and respiratory physicians. In the control group, spirometry was performed, and the patients continued to receive usual care from their regular physicians. The outcomes were assessed by a questionnaire six months after entry into the study. RESULTS: Ninety-three subjects entered the study and were randomly assigned to the intervention or control group. Of these, only 62 patients were available for review after six months. Subjects in both the control and the intervention groups showed a marked improvement in their level of asthma control, reflected primarily by a 73% reduction in the rate of emergency department attendance for asthma. Other indexes of disease control, including disease-specific quality of life, as assessed by questionnaires, were improved. There was, however, no discernible difference between the subjects in the two groups, with the exception of an improvement in favour of the intervention group in the symptom (actual difference 0.7, P=0.048) and emotional (actual difference 0.8, P=0.028) domains of the asthma quality of life questionnaire. The overall quality of life score favoured the intervention group by a clinically relevant difference of 0.6, but this difference did not reach statistical significance (P=0.06). CONCLUSIONS: Although all subjects demonstrated a significant improvement in asthma control and quality of life, the improvement attributable to this intervention was limited to two domains in disease-specific quality of life.

Adolescent↗
PubMed1999

Developments in caries diagnosis and their relationship to treatment decisions and quality of care. ORCA Saturday Afternoon Symposium 1997.

This symposium report evaluates the achievements made in caries diagnostic research since the previous symposium held in 1992. The symposium aimed at presenting the state of the art of caries diagnostic methods, on presenting the links between caries diagnosis and subsequent treatment decisions and their effect on the treatment outcomes, particularly the quality of dental care. The variation among dentists in diagnosing (small) caries lesions and in treatment decision making is considerable. This has been explained by the imperfection of caries decision making tests, but also by making incorrect treatment decisions due to incorrect or partial understanding of diagnostic test parameters. Meta-analyses into the performance of caries diagnostic tests revealed that the available quantitative methods are very promising. It was concluded that these methods had high correlations with lesion depth. They were considered suitable to monitor small changes in lesions. Many obstacles have been experienced in attempting to transfer the outcomes of diagnostic research into clinical practice and it was concluded that caries diagnosis researchers should co-operate with manufacturers to introducing valid new diagnostic tools to the market. Main research priorities for the coming 10 years are to conduct cost-effectiveness and cost-utility studies of caries diagnostic tools, to continue to review the performances of diagnostic tests, to transfer diagnostic knowledge and experience to the general practitioners particularly by constructing evidence-based clinical guide-lines, to study the relationship between diagnosis and treatment decision, and to assess the effect of diagnostic and treatment decisions on the outcome of care.

Cost-Benefit Analysis↗
PubMed2004

[Must the postgraduate medical training for specialists of gynecology and obstetrics be reconsidered?].

Our specialty is based on a 3-pillared concept. The professional political development again requires a discussion on the separation of 'nonoperating' and 'operating' specialists. In addition, the future model of the 'gynecologist as family doctor for women' becomes an interesting topic. The guidelines for the proceedings in the case of suspect and positive cytological smears of the cervix have been revised with regard to the Bethesda nomenclature and will be published this year.

Clinical Competence↗
PubMed2006

Early mobilisation after stroke: Review of the literature.

BACKGROUND: Mobilisation of acute stroke patients--in bed and out of bed as early as possible--is currently recommended to prevent general and neurological complications. However, mobilisation protocols are poorly defined and need to be standardised in order to evaluate their clinical benefits. The purpose of this study is to highlight recent advances in recommendations for mobilisation of acute stroke and early neurological rehabilitation as found in the recent literature. METHODS: A Medline research was conducted from January 1950 to August 2005. RESULTS: Data synthesis of the observational studies and meta-analyses suggests that for most patients with acute stroke, early mobilisation is not harmful and may well be beneficial. However, no controlled study exists comparing early (e.g. 1-3 days) versus late (e.g. 1-2 weeks) mobilisation. Based on the available data and on pathophysiological considerations, we have developed a partially individualised procedure with precise entry and exit points for early mobilisation according to clinical status. CONCLUSIONS: Insufficient data are available to prove the beneficial effects of early mobilisation after stroke, although early neurological rehabilitation as part of routine stroke unit care seems to contribute to good long-term outcome. This article presents a standardised procedure for early mobilisation that may be tested in a randomised study between early mobilisation out of bed (3 days) compared to late mobilisation (6 days).

Clinical Trials as Topic↗