ABSTRACT
BACKGROUND: In more and more countries, a specific pain education curriculum is provided to instruct pain physicians. However, there is little literature on pain education and in particularly how to evaluate their knowledge. One of the modules interesting to assess is the use of clinical practice guidelines (CPGs) by pain physicians. OBJECTIVES: The aim was to investigate if a case vignette is useful to evaluate pain physicians' knowledge about recommendations contained in CPGs. SETTING: An email survey was conducted with the support of the Societe Francaise d'Etude et de Traitement de la Douleur to all pain specialists (primary and secondary care) in France. METHODS: The survey consisted of a case vignette about a patient with pain suffering from an intractable pancreatic cancer with multiple choice questions about diagnosis and treatment of pain. Percentages of participants who treated the patient as suggested in the CPGs were calculated. RESULTS: A total of 214 of those invited to participate (921) answered the questionnaire (24%). More than 85% of the respondents declared to know and use CPGs. Half of the participants diagnosed and treated neuropathic pain components in the case vignette according to the recommendations in the CPGs. LIMITATIONS: This exercise needed to be explained: pain physicians should be trained to this kind of questionnaire. It explains the low response rate and the progressive diminution of responders during the questionnaire. CONCLUSIONS: Case vignette is an interesting instrument for pain education because it is cheap, easy to use, and can be repeated. However, training before using this instrument is needed for pain physicians, in particular during their pain education.
Subject(s)
Education, Medical, Continuing/methods , Health Knowledge, Attitudes, Practice , Physicians , Practice Guidelines as Topic , Adult , Aged , Female , France , Humans , Male , Middle Aged , Neoplasms/complications , Neuralgia/diagnosis , Neuralgia/etiology , Neuralgia/therapy , Pancreatic Neoplasms/complications , SpecializationABSTRACT
AIM: The evidence on the acute effects of smoking on biomarkers is limited. Our aim was to study the acute effect of smoking on disease-related biomarkers. METHODS: The acute effect of smoking on serum high sensitivity CRP (hs-CRP) and plasma fibrinogen and its association with disease severity was studied by challenging 31 chronic obstructive pulmonary disease patients with cigarette smoking and repeatedly measuring these biomarkers before and after smoking. RESULTS: Fibrinogen and hs-CRP increased directly after smoking by 9.4 mg/dl (95% CI: 4.2-14.5) and 0.13 mg/l (95% CI: 0.03-0.23), respectively. Fibrinogen levels remained elevated after 35 min, whereas hs-CRP normalized. Pearson's correlation coefficient between the hs-CRP change and chronic obstructive pulmonary disease severity was 0.25 (p = 0.06). CONCLUSION: Fibrinogen and hs-CRP increased directly after smoking in the chronic obstructive pulmonary disease patients. Their association with disease risk and/or progression remains to be demonstrated.
Subject(s)
C-Reactive Protein/metabolism , Fibrinogen/metabolism , Pulmonary Disease, Chronic Obstructive/blood , Smoking/adverse effects , Adult , Aged , Aged, 80 and over , Biomarkers/blood , C-Reactive Protein/analysis , Female , Fibrinogen/analysis , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/diagnosisABSTRACT
BACKGROUND: A growing number of prognostic indices for chronic obstructive pulmonary disease (COPD) is developed for clinical use. Our aim is to identify, summarize and compare all published prognostic COPD indices, and to discuss their performance, usefulness and implementation in daily practice. METHODS: We performed a systematic literature search in both Pubmed and Embase up to September 2010. Selection criteria included primary publications of indices developed for stable COPD patients, that predict future outcome by a multidimensional scoring system, developed for and validated with COPD patients only. Two reviewers independently assessed the index quality using a structured screening form for systematically scoring prognostic studies. RESULTS: Of 7,028 articles screened, 13 studies comprising 15 indices were included. Only 1 index had been explored for its application in daily practice. We observed 21 different predictors and 7 prognostic outcomes, the latter reflecting mortality, hospitalization and exacerbation. Consistent strong predictors were FEV1 percentage predicted, age and dyspnoea. The quality of the studies underlying the indices varied between fairly poor and good. Statistical methods to assess the predictive abilities of the indices were heterogenic. They generally revealed moderate to good discrimination, when measured. LIMITATIONS: We focused on prognostic indices for stable disease only and, inevitably, quality judgment was prone to subjectivity. CONCLUSIONS: We identified 15 prognostic COPD indices. Although the prognostic performance of some of the indices has been validated, they all lack sufficient evidence for implementation. Whether or not the use of prognostic indices improves COPD disease management or patients' health is currently unknown; impact studies are required to establish this.
Subject(s)
Data Interpretation, Statistical , Hospitalization/statistics & numerical data , Proportional Hazards Models , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/mortality , Respiratory Function Tests/statistics & numerical data , Survival Analysis , Humans , Prevalence , Prognosis , Reproducibility of Results , Risk Assessment/methods , Risk Factors , Sensitivity and Specificity , Survival RateABSTRACT
AIM: To determine the effect of a distance learning programme on general practice management of men with lower urinary tract symptoms (LUTS). METHODS: A cluster randomised controlled trial was performed. General practitioners (GPs) were randomised to a distance learning programme accompanied with educational materials or to a control group only receiving mailed clinical guidelines on LUTS. Clinical management was considered as outcome. RESULTS: Sixty-three GPs registered care management of 187 patients older than 50 years attending the practice because of LUTS. The intervention group showed a lower referral rate to a urologist (OR: 0.08 (95% CI: 0.02-0.40)), but no effect on PSA testing or prescription of medication. PSA testing tended to be requested more frequently by intervention group GPs. Secondary analysis showed patients in the intervention group received more educational materials (OR: 75.6 (95% CI: 13.60-419.90)). CONCLUSIONS: The educational programme had impact on clinical management without changing PSA testing. Distance learning is an promising method for continuing education. PRACTICE IMPLICATIONS: Activating distance learning packages are a potentially effective method for improving professional performance. Emotional matters as PSA testing probably need a more complex approach.
