Implementation of clinical guidelines in Brazil : should academic detailing be used?

Objective: The Brazilian National Health System provides high cost medicines through the Specialized Component of Pharmaceutical Assistance in accordance with adherence to agreed Clinical Guidelines. However, physician compliance to these Guidelines, as well as the barriers and facilitators related to them and the influence on the subsequent quality of care provided is unknown. Consequently, the objectives of this paper are to undertake a review of international experiences and scientific publications of a strategy to disseminate and communicate guidelines to physicians through Academic Detailing. Subsequently use the findings to develop and conduct a pilot Academic Detailing Program in Brazil targeting specialists who prescribe medicines for patients with Alzheimer’s disease, which are part of the Specialized Component of Pharmaceutical Assistance. Methods: Review international experiences and scientific publications relating to academic detailing based on a thorough review of available literature including publications known to the co-authors. Develop and monitor physician acceptance of academic detailing for patients with Alzheimer’s Disease and the impact on future prescribing. Key findings: Based on the lessons learnt from the international experience and review, coupled with the initial experiences in Brazil, we conclude that conducting academic detailing to enhance the implementation and dissemination of clinical protocols and therapeutic guidelines in Brazil is worthwhile. We will be closely monitoring the outcome of the pilot academic detailing programme as a basis for developing future programmes to further improve the quality of prescribing in Brazil. Conclusion: Findings from the experiences are encouraging. This will be further explored to provide a basis for this approach in the future

Multibeam Mapping of Selected Areas of the Outer Continental Shelf, Northwestern Gulf of Mexico - Data, Images and GIS

Following the publication of high-resolution (5-meter spatial resolution) multibeam echosounder (MBES) images of the Flower Garden Banks National Marine Sanctuary area of the northwestern Gulf of Mexico (Gardner et al., 1998), the Flower Garden Banks National Marine Sanctuary (FGBNMS) and the Minerals Management Service (MMS) have been interested in additional MBES data in the area. A coalition of FGBNMS, MMS, and the U.S. Geological Survey (USGS) was formed to map additional areas of interest in the northwestern Gulf of Mexico (fig. 1) in 2002. FGBNMS chose the survey areas, and the USGS chose the MBES. MMS and FGBNMS funded the mapping, and the USGS organized the ship and multibeam systems through a cooperative agreement between the USGS and the University of New Brunswick. The objective of the cruise was to map 12 regions of interest to MMS and the FGBNMS, including Alderdice, Sonnier, Geyer, Bright, Rankin (1 and 2), Jakkula, McNeil, Bouma, McGrail, Rezak, and Sidner Banks

Preserving antibiotics for the future: where Australian general practice sits on the global spectrum

Background: Antibiotics have revolutionised modern medicine; however, since their discovery a century ago, their effectiveness against common infections is waning. Antimicrobial resistance is one of the most important challenges of our time. Reversing the trend of increasing resistance is vital to ensure procedures such as surgery, neonatal care and organ transplants remain safe. Inappropriate use of antibiotics is the most important driver of resistance. As the vast majority of antibiotics are prescribed by general practitioners, primary care has an important part to play in preserving antibiotics for the future. Objective: The aim of this article is to describe how antibiotic use in Australia compares globally and what can be learnt from countries with successful antimicrobial stewardship. Discussion: Australia is making progress, with unnecessary use of antibiotics declining, but there is still a long way to go. The National Antimicrobial Resistance Strategy is Australia's commitment to the health of future generations. General practice is integral to its success