are italian pulmonologists aware of the guidelines for asthma management and do they know how to apply them

Background. Since 1995 GINA (Global Initiative on Asthma) guidelines for asthma management have been updated annually and published in order to promote better management of asthma in real life situations. The aim of our study was to assess the level of implementation of GINA Guidelines among Italian Pulmonary Specialists (PSs). Methods. A detailed questionnaire was sent to 296 Respiratory Units (RUs) in Italy in order to collect information about personnel involved in the management of asthma patients, availability and use of diagnostic tools, recommended treatment according to the degree of asthma severity, educational activity. Data were analysed by using the SPSS programme. Results. 74 (25%) questionnaires were returned and analysed. Most RUs (70%) do not have a dedicated asthma clinic; however, spirometry is available in more than 90% of RUs, although it is performed in no more than 50% of patients in most RUs. Asthma treatment concurs with GINA recommendations in most RUs. Educational activity is performed by almost all RUs, usually in informal manner, during clinical visits, whereas only few RUs arrange individual educational sessions or "asthma school". Conclusions. GINA guidelines for asthma management are applied by most Italian RUs included in this study in regard to educational activity and, to a lesser extent, to treatment. Surprisingly, many RUs perform spirometry in a relatively small number of patients despite its availability

Knowledge and health care resource allocation: CME/CPD course guidelines-based efficacy.

BACKGROUND: Most health care systems consider continuing medical education a potential tool to improve quality of care and reduce disease management costs. Its efficacy in general practitioners needs to be further explored. OBJECTIVE: This study assesses the effectiveness of a one-year continuing medical education/continuing professional development course for general practitioners, regarding the improvement in knowledge of ARIA and GINA guidelines and compliance with them in asthma management. METHODS: Sixty general practitioners, covering 68,146 inhabitants, were randomly allocated to continuing medical education/continuing professional development (five residential events +four short distance-learning refresher courses over one year) or no training. Participants completed a questionnaire after each continuing medical education event; key questions were repeated at least twice. The Local Health Unit prescription database was used to verify prescription habits (diagnostic investigations and pharmacological therapy) and hospitalizations over one year before and after training. RESULTS: Fourteen general practitioners (46.7%) reached the cut-off of 50% attendance of the training courses. Knowledge improved significantly after training (p < 0.001, correct answers to key questions +13%). Training resulted in pharmaceutical cost containment (trained general practitioners +0.5% vs. controls +18.8%) and greater attention to diagnosis and monitoring (increase in spirometry +63.4%, p < 0.01). CONCLUSION: This study revealed an encouraging impact of educational events on improvement in general practitioner knowledge of guidelines and daily practice behavioral changes. Long-term studies of large populations are required to assess the effectiveness of education on the behavior of physicians in asthma management, and to establish the best format for educational events

Antarctica, ice fall on Taylor Glacier in Windy Gully, Victoria Land

Windy Gully ice fall from Taylor glacier, Taylor Valley, Antarctic

Antarctica, Wilson Piedmont Glacier in Victoria Land

Whaleback clouds over Wilson Piedmont glacier, Marble Pt., Antarctic

Antarctica, rock formation at Windy Gully area, Victoria Land

Lower Beacon - Widich for scale - Windy Gully, Victoria Lan

Antarctica, Taylor Valley in Victoria Land

Taylor Dry Valley, with open lake - Antarctic

Antarctica, shape charge blast at Marble Point, Victoria Land

Shape charge blast, Bill Hill, Marble Pt., Antarctic

Antarctica, Lake Bonney in Taylor Valley, Victoria Land

Bonnie Lake [Lake Bonney] - N. Wall, Taylor Valley Area, Victoria Land, Antarctic

Antarctica, aerial view of Ross Ice Shelf, Little America Basin

Ross Ice Barrier, Little America, Antarctic

Antarctica, aerial view of ice fall at Royal Society Range near Taylor Valley

Ice Fall Royal Society Range, Taylor Valley, Victoria Land, Antarctic