Need For Continuing Medical Education Research Articles

The practice of breast self-examination and associated factors among female healthcare professionals working in selected hospitals in Kigali, Rwanda: a cross sectional study

BackgroundBreast self-examination (BSE) is considered one of the main screening methods in detecting earlier stages of breast cancer. It is a useful technique if practiced every month by women above 20 years considering that breast cancer among women globally contributed to 685,000 deaths in 2020. However, the practice of breast self-examination among healthcare professionals is low in many developing countries and it is not well known in Rwanda. Therefore, this research was intended to measure the level of breast self-examination practice and its associated factors among female healthcare professionals working in selected hospitals in Kigali, Rwanda.MethodsA cross-sectional study was conducted among 221 randomly selected female healthcare professionals in four district hospitals in Kigali, Rwanda. A self-administered structured questionnaire was used as data collection instrument. The predictor variables were socio-demographic and obstetrics variables, knowledge on breast cancer and breast self-examination as well as attitude towards breast cancer and breast self-examination. Sample statistics such as frequencies, proportions and mean were used to recapitulate the findings in univariate analysis. Multiple logistic regression analysis was employed to identify statistically significant variables that predict breast self-examination practice. Adjusted odds ratio with 95% confidence level were reported. P-value < 0.05 was used to declare statistical significance.ResultsBreast self-examination was practiced by 43.5% of female healthcare professionals. This prevalence is low compared to other studies. Attitude towards breast self-examination and breast cancer was the only predictor variable that was significantly associated with breast self-examination practice [AOR = 1.032; 95% CI (1.001, 1.065), p-value = 0.042]. However, number of pregnancy and number of children were not significantly associated with BSE practice in the multi-variate analysis. In addition, there was a positive linear link between knowledge and attitude, with a correlation coefficient (r) of 0.186 (p = 0.005).ConclusionsThe breast self-examination practice among healthcare professionals was found to be low. Attitude towards breast cancer and breast self-examination was positively associated with BSE practice. Moreover, attitude and knowledge were positively correlated. This suggests the need for continuous medical education on breast self-examination and breast cancer to increase the knowledge & BSE practice level of female healthcare professionals.

Thực trạng đào tạo liên tục của điều dưỡng tại Bệnh viện 199, Đà Nẵng giai đoạn 2020 – 2022

A cross-sectional descriptive study, combining quantitative and qualitative methods was conduct to describe the current situation and the need for continuous medical education (CME) of nurses at 199 Hospital in the period of 2020 - 2022. Quantitative research on questionnaires on 219 nurses, qualitative research conducted 03 in-depth interviews with management subjects and 04 nursing group discussions. The percentage of nurses participating in continuous education in professional care for patients and performing nursing techniques is still low, less than 50%. The lowest is taking care of dying patients and deceased ones (30.6% in 2022). Current status of continuous education for nurses during the Covid-19 epidemic, the lowest percentage is Telenursing (43.8% in 2021). About other fields, the lowest is scientific research at 26% (2022). In conclusion, the percentage of nurses participating in nursing practice is still low in 2020-2021, and the demand for nursing training in nursing is not high in 2022 and the following years, only high for some management positions. The study makes recommendations to encourage nurses to participate in CME courses to achieve 100% rate. Keywords: Nurses, continuing medical education, hospital.

Nhu cầu đào tạo liên tục của điều dưỡng lâm sàng khối Nội và khối Ngoại và một số yếu tố ảnh hưởng tại Bệnh viện đa khoa trung tâm Tiền Giang năm 2021

The study aimed to describe the needs and determine influenced factors continuous medical education needs among nurses in Tien Giang general hospital in 2021. A cross-sectional study was conducted with combining quantitative and qualitative approaches. A total of 246 clinical nurses was selected in this study for a self-administered questionnaire and the hospital director, head nurse, and nurses were invited for in-depth interview and focus group discussions. The results showed that 95.1% of nurses had a need for continuous medical education, in which the highest need was training in soft skills and patient care techniques. The desired training location was at the provincial general hospital, the duration of the training course was less than 7 days. Most clinical nurses chose the form of concentrated training that combines theory and practice approaches. Some factors related to financial issues, the burden of workload and job position were negative influenced factors on the training need of clinical nurses. Other factors including need for promotion, and training management were positive influenced factors on continuous medical training among clinical nurses. Keywords: Continous Medical Educaltion (CME), training need assessment, nurses, hosipital, Tien Giang general hospital

Knowledge, Attitude and Practices of Health Care Workers towards NOMA in a Tertiary Institution in North-western Nigeria

Background: NOMA is a potentially life-threatening necrotizing condition characterized by the destruction of oral and perioral tissues. NOMA is fatal in 90% of cases but the rate is reduced to about 8% with early recognition and treatment.&#x0D; Objective: To evaluate the knowledge, attitude, and practices of health workers towards Noma in a tertiary teaching hospital in north-western Nigeria.&#x0D; Methods: This was a cross-sectional study carried out among health care personnel using a self-administered questionnaire between October 2019 and February 2020. The questionnaire consisted of 20 questions covering the domains of knowledge and, attitude/practices. The total score for each domain was obtained and then categorized as low (less than or equal to 50%), fair (51 to 69%), and good (70% and above).&#x0D; Results: A total of 156 respondents filled and returned the questionnaires. Male respondents constituted 103(66%) as against 53(34%) Female respondents. The age range of respondents was 19 –54 years with a mean±SD of 32.8±6.6 years. Out of 156 respondents, 123(78.8%) were aware of Noma. The total score recorded in both the knowledge and attitude/practice domains were 72.5% and 47.5% respectively.&#x0D; Conclusion: The awareness of Noma among the study population was good. Those that were aware of the disease have good knowledge of it, however, the attitude and practices were low. Therefore, there is a need for continuous medical education among health care workers.&#x0D;

Patients’ reactions to digital rectal examination of the prostate

Background: Digital rectal examination (DRE) of the prostate is a simple, fast, cost effective and safe procedure, however, because of previous painful experience, some men may refuse it. Other negative factors include cultural barriers, fear of discovering cancer and embarrassments. However, some men accept DRE because of their symptoms and wishes to contribute to science. The aim of this study was to examine how previous experience of DRE could influence a repeat and to further evaluate their impression before and after DRE including pain score.Patients and Methods: We evaluated one hundred patients who met the inclusion criteria using a structured questionnaire that detailed information on patients biodata, their previous DRE experiences, expectations before and reactions after a repeat. Pain score was also examined using visual analog scale of 0 to 10. Data were collated and analysed using statistical package for social sciences (SPSS) version 20.0. P-value was set at &lt;0.05.Results: Mean age of patients was 64.88±7.53 years ranging from 46 to 82 years. Forty five percent of them complained of pain from previous DRE while 55% reported no pain. Forty one percent of the men anticipated pain before this present procedure but only 8% of them reported that it was painful and humiliating after the procedure. Fifty nine percent had good impression before DRE and after the procedure 92% reported good impression. All patients expressed their willingness to repeat DRE in future if need be and to encourage friends who may need DRE evaluation of their condition. Mean pain score was 0.59 ± 1.349 (0 – 9).Conclusion: Patients previous experience of DRE could negatively influence a repeat procedure because of pain, improper counseling apart from some cultural barriers. DRE in the hands of Urologists has been better tolerated than other clinicians. This calls for proper exposure of medical students to this procedure and need for continuous medical education for other clinicians for skills improvement.

The Need for Mandatory Mental Health Continuing Education among Registered Nurses

Continuing medical education is integral to lifelong learning and constitutes a vital aspect of keeping registered nurses’ knowledge and skills up to date. This supports best practices and the effectiveness of any interventions. Therefore, the aim of this study was to explore the need for mandatory mental health continuing education for practicing registered nurses. This was a descriptive cross-sectional quantitative study with a sample size of 27 registered nurses working in Health care settings in the Cayman Islands. These participants were selected using non-probability sampling technique. Convenience sampling was the chosen method. A 25 items Questionnaire was used to collect the data. Closed-ended questions, and a Likert scale were used to collect the demographic data and to measure the nurses’ perceptions of the need for the intervention under study. Analysis of the data was accomplished with Microsoft Excel. Descriptive statistics were generated. The results revealed that only a few registered nurses were extremely confident (7.40%) or quite confident (37.0 4%) in their ability to manage the care of patients with mental illnesses. The majority (88.89%) of nurses believed that there is a need for continuous medical education in mental health topics and that it should be mandatory (92%) for registered nurses. They believe and that this will make them more confident in their delivery of care to patients with underlying mental illnesses. Hence, it can be concluded that continuing education in this aspect of nursing will be beneficial for both them and the patients they care for.

Current State of Affairs with Regard to Continuing Medical Education for Technicians in Radiology in Francophone West Africa

Background: This study aimed to determine the level of continuing medical education (CME) of medical imaging technicians in French-speaking West Africa. Materials and methods: This opinion survey was administered to radiology technicians in French-speaking West Africa from 1st June to 31st October 2020, i.e. over a period of 5 months concerning their level of CME and their need for CME. Results: Out of 100 technicians, 69% were men. The mean age was 40 years, with extremes ranging from age 23 to age 57. The majority of technicians (64%) worked in the public sector and 78% had work experience of less than 11 years. Most technicians were holders of a Bachelor’s degree (73%). The types of CMEs they knew were congresses, seminars, and modular training in 46% of the cases. The most available CMEs were seminars (63%). All technicians agreed on the need for CME and 96% said it had an impact on the delivery of radiology services. Technicians who had received CME at least once represented 61%. For 90% of technicians, the specific CME sought was management in radiology (33.33%) and radiation protection (25.81%). Conclusion: The need for CME is increasingly indisputable to radiology technicians in French-speaking West Africa; however, it remains a luxury for them, due to its scarcity and its high cost.

Mothers' false beliefs and myths associated with teething.

Background: Teething is a physiological process experienced by all children. However, many unrelated illnesses are blamed on teething.Objective: The aim of this study was to assess mothers’ beliefs toward teething and to investigate the practices preferred by mothers to alleviate symptoms that might accompany the teething process.Methods: A cross-sectional study was conducted in Basra. The study population includes mothers of young children aged (6–30) months who had at least one erupted primary tooth, and who had no history of medical or systemic disease that might affect teething. Two hundred mothers of different age groups and educational backgrounds responded to a questionnaire that included information on the child's age and birth order, mother's age, level of education, occupation, number of children, beliefs toward teething symptoms, and the practices preferred to relieve the attributed symptoms. Data has been presented in numbers and percentages, the Chi-square test was performed where appropriate, and a p value of < 0.05 was considered significant.Results: All (100%) participants attributed at least one symptom or sign to the teething process. The most common symptoms reported were fever (70%), diarrhea (68.5%), and sleep disturbance (63.5%).Sixty-eight percent of mothers believed teething remedies were effective; only 10 (5%) did not give any treatment. Over half (62%) gave medications, such as antipyretics, antibiotics, and antidiarrheal agents. Some used teething gels (29%), pacifiers (50%), gum massage (22%), and hard foods such as biscuits and carrots (43.5%). Mothers of various educational levels reported attributed symptoms, and the result was statistically significant (p < 0.05). Mothers of a firstborn child were found to have a higher tendency to attribute symptoms to teething than those who had previous experience with children (p < 0.05).Discussion and conclusions: Teething myths and misconceptions are common among mothers. The study identified a significant number of doctors, dentists, and pharmacists still attribute many symptoms and signs to teething despite the lack of supporting evidence. Therefore, the findings of this study highlight the need for continuous medical education and nationwide prospective studies to eradicate these false beliefs.

Assessing Knowledge of Zika Virus and a need for Continuous Medical Education (CME) in Post-Graduate Doctors of a Tertiary Care Hospital: A Single Center Experience

Background: The 2015-2016 Zika Virus Outbreak caused global concern. A study was done to assess knowledge about viral hemorrhagic fevers amongst healthcare professionals, which found only 57% doctors knew clinical features of hemorrhagic viral fever. The aim of this research was to assess the knowledge of physicians as well as the need for continuous medical education. Methods: A cross-sectional study was conducted on doctors working or undergoing postgraduate training in a private tertiary care hospital. A sample size of n=91 was reached after including most of the doctors working in these hospitals in the department of medicine, pediatrics, gynecology and obstetrics. Data was collected through self-administered questionnaire. Convenience sampling technique was employed. Informed oral consent was taken before administration of questionnaire. Analysis was done on SPSS version 20. Results: The doctors included in the study were from the departments of internal medicine, which were 46.2% (42), pediatrics, which were 19.8% (18), and gynecology and obstetrics. Only 17.6% (n=16) participants knew that the Zika virus can affect pregnant women in any trimester. If pregnant woman is infected only 65.9% (n=60) of all doctors were aware of the fact that it can cause microcephaly in the infants. Thus, 44% (n=40) of the participants demonstrated correct knowledge that Zika virus is associated with the Guillain-Barré syndrome (GBS). Conclusion: Our study determined that although many doctors demonstrated good knowledge regarding the clinical features of Zika virus, they had poor knowledge regarding the prevention of spread of disease.

Diabetes education and basic insulin related knowledge assessment in nursing staff in a tertiary care hospital in India

Nursing staff plays a major role in the delivery of insulin to hospitalized patients. We aimed at studying the adequacy of desired knowledge related to insulin in nursing staff in a tertiary care government-funded teaching hospital in India. A cross-sectional descriptive design study was conducted to assess the basic insulin-related knowledge in nursing staff by a self-administered questionnaire. A total of 101 nursing staff accepted to participate in the study and returned the completed questionnaire. Forty-one participants were female and 60 were male. Almost 80% of participants denied as trained for diabetes management in hospitalized patients in their nursing curriculum. Eighty-seven participants were comfortable giving insulin. Only two participants could identify basal and bolus insulin as the type of insulin needed to manage hyperglycemia. Twenty-five participants could identify the strengths of insulin vials available in India and only 8 could correctly mention the colour code of the corresponding insulin syringe. Only 15 participants could correctly identify the commonly used routes of inulin administration. Thirty participants could identify all the correct subcutaneous injection sites, however, at least one wrong site was chosen by 78 participants and 8 participants did not answer. A similar deficit in knowledge was seen in hypoglycemia management, glucose monitoring, insulin storage, expiry of inulin and injection techniques. This study shows a significant deficit in basic insulin-related knowledge in nursing staff. There is a need for continuous medical education of nursing staff to stay updated on Diabetes management.

Awareness, Practices, and Demands of Traditional Medicine Providers for Continuous Medical Education in District Hospitals of Vietnam.

Expanding traditional medicine (TM) coverage in health care is a priority in Vietnam. Continuous medical education (CME) plays an important role in ensuring the quality of TM. However, evidence about TM CME in TM practitioners in Vietnam is insufficient. This paper aimed to evaluate the awareness, practice, and demands on TM CME among TM providers in district hospitals of Vietnam. This cross-sectional descriptive study was performed at the district level at TM hospitals and TM departments of general hospitals in Thanh Hoa Province. Demographic characteristics, awareness, practice, and demand for TM CME were collected via face-to-face interviews. Descriptive statistics and multivariable logistic regression models were applied to examine the factors associated with awareness, practice, and demand for TM CME. The majority of the respondents had ever heard of TM CME (87.5%). Only 60% received TM training in the last five years. Most respondents had a demand for CME (86.8%). The non-Kinh ethnic group (OR = 0.2, 95% CI: 0.1–0.8) and people who had a temporary contract (OR = 0.2, 95% CI: 0.1–0.7) were less likely to be ever heard about TM CME. Higher levels of education (college, OR = 14.1, 95% CI = 1.0–195.9; undergraduate, OR = 9.1, 95% CI = 1.9–44.6) are more likely to be ever heard of TM CME than the vocational training group. Those who regularly update their knowledge are more likely to have heard about TM CME (OR = 7.7, 95% CI = 2.8–21.7) and are more likely to have demands on TM CME (OR = 3.7, 95% CI = 1.2–11.5). Those who had heard about TM CME were more likely to take these courses in the last five years (OR = 6.9, 95% CI = 2.5–18.8). However, this result was the opposite for people with more years of experience (OR = 0.9, 95% CI: 0.8–0.9). There were limited awareness and participation in TM CME but was a high need for CME among TM providers at district hospitals in Vietnam. Promoting lifelong learning and providing promptly supports would be potential to increase the TM CME demands and participation among TM providers.

Long-term impact on contouring skills achieved by online learning. An ESTRO-FALCON-IAEA study

The weakest point in conformal radiotherapy (RT) is heterogeneity in contouring of target volumes (TV) and organs at risk (OAR). Interactive online learning has shown immediate improvement of homogeneity in contouring but the long-term effect is unknown. The aim of this multicenter study was to evaluate the short- and long-term impact of online learning on homogeneity in contouring for 3D RT and to evaluate the feasibility of blended learning in centers from low- and middle-income countries (LMIC) that have recently transitioned from 2D to 3D RT. 60 Radiation Oncologists (RO) from 14 centers in 13 countries were invited. Participants delineated TV and OAR on a treatment planning CT in the FALCON-EduCase online system. The teaching program involved three tumor sites: head and neck (HN), lung and cervix. Four delineations per tumor site were planned: one before the teaching period, two during the teaching period (at 1 week and 1 month) and finally a fourth without teaching 6 months later. As soon as one teaching program had finished another started for another site. In total 12 delineations for 3 cases were contoured over a year. Participants were blind to the DICE index and qualitative measures, which would be used as endpoints. Compliance to the program was >50%. The majority (88%) used 3D RT routinely. For HN part, 57 RO delineated, significant increases were seen in homogeneity of contouring for TV and OAR. DICE increased immediately during the teaching sessions and remained high even 6 months after teaching (p<0.0001 for the elective CTV and right parotid for example). That was also reflected qualitatively with an increase from 4% to 94% RO delineating the levels suggested by the guidelines after 6 months. Similar improvements were recorded for OAR. For the cervical cancer part, 46 RO delineated, significant increases were seen in homogeneity of contouring for TV and OAR except for sigmoid colon (table 1). CTV T and N DICE increased immediately after teaching, remained high after 1 month, and showed a slight decreasing trend at 6 months. Similar results were recorded for OAR, such as bladder and rectum (table 1). Qualitative improvement was observed with an increase from 12% to 79% and 59% of the RO who correctly included parametria in the CTV T from first delineation to the delineation at 1 month and at 6 months, respectively. The trend to partly lose learning benefit was also seen with this qualitative analysis. Online teaching in LMIC seems feasible with an acceptable compliance to the learning program. The learning obtained on a short-term basis was shown to be sustainable 1 and 6 months after teaching but the benefit might be decreasing over time suggesting the need for continuous medical education in the field of contouring.Abstract TU_4_2929; Table 1Mean DICE for TV and OAR of cervical cancer casebefore lecture (n=30)1 week (n=35)1 month (n=19)6 months (n=27)CTV T0.580.770.790.71CTV N0.510.670.710.61Rectum0.650.720.740.68Bladder0.640.800.800.74Sigmoid0.190.200.230.21 Open table in a new tab

A prospective observational study of prescription pattern of topical steroids in dermatology OPD, BRIMS, Bidar, India

Background: In dermatology practice Glucocorticoids are the most commonly prescribed drugs. Steroids produce dramatic relief in inflammatory and pruritic skin conditions, if they are irrationally used they may lead to adverse effects. Hence this study was done to observe the prescription pattern of corticosteroids.Methods: It was a prospective observational study. The prescriptions of patient attending the dermatology OPD were screened for the usage of the corticosteroids. The demographic data, chief complaints, diagnosis and the details of the drugs were collected and analysed.Results: Out of 415 patients screened, 13.97% were prescribed corticosteroids. Corticosteroids prescribed by generic name were 26.01% and brand name was 82.05%. Corticosteroids alone were prescribed in 42.02% and along with antihistaminics/antibiotics/emollients in 66.04%. Corticosteroids were prescribed topically in 86.02% of patients and systemically in 22.04% of patients. Moderately potent steroids prescribed in 80.42% followed by potent (15.07%) and very potent steroids (12.56%). No fixed dose combination drugs were prescribed.Conclusions: The corticosteroids prescribed by brand names (82.05%) were more than generic names (26.01%), information about the strength of the steroid was not mentioned and usage of emollients was less. This indicates the need for continuous medical education for the clinicians.

Health workers' knowledge on future vascular disease risk in women with pre-eclampsia in south western Nigeria.

Background Pre-eclampsia progressing to eclampsia is one of the major causes of maternal death in Nigeria. Since there is long term association of pre-eclampsia with cardiovascular disease, cerebrovascular disease, renal disease, short life expectancy and mortality, it is essential to obtain obstetric history for better counseling and long term monitoring. The study assessed the knowledge of health workers about the association of pre-eclampsia with future cardiovascular disease and offering any risk-reduction counseling to women with pre-eclampsia.MethodsDuring a training workshop, a validated questionnaire on the association between pre-eclampsia and cardiovascular risk was distributed among health care workers working at the infant welfare and family planning clinics in Osun State. Data were analysed using descriptive and inferential statistics.ResultsOne hundred and forty-six out of 150 health workers approached participated in the study (response rate 97.3 %). Mean age of respondents was 35.6 ± 9.1 years. Median age of practice was 7 years, ranging from 1–40 years. They were medical doctors (60.3 %), community health workers (26.7 %) and nurses/midwives (13.0 %). Most participants had good knowledge on future cardiovascular risk of pre-eclampsia. The medical doctors had better knowledge compared to nurses/midwives and community health workers (78.4 vs. 57.9 vs. 53.8 %; p < 0.05). Below half (45.9 %) offered risk-reduction counseling.ConclusionKnowledge of the cardiovascular risk factors was lower among the nurses/midwives and community health workers. Risk reduction counseling was quite low across all the health workers. There is need for continuous medical education and possible review of the training curriculum of the lower cadres of health workers.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1553-6) contains supplementary material, which is available to authorized users.

Prehospital personnel's attitudes to pain management

ObjectivesPain is one of the most common reasons for patients to seek acute medical care. The management of pain is often inadequate both in the prehospital setting and in the emergency department. Our aim was to evaluate the attitudes towards pain management among prehospital personnel in two Scandinavian metropolitan areas. MethodsA questionnaire with 36 items was distributed to prehospital personnel working in Helsinki, Finland (n=70) and to prehospital personnel working in Stockholm, Sweden (n=634). Each item was weighted on a five-level Likert scale. Factor loading of the questionnaire was made using maximum likelihood analysis and varimax rotation. Six scales were constructed (Hesitation, Encouragement, Side effects, Evaluation, Perceptions, Pain metre). A Student's t-test, ANOVA, and Pearson Correlation were used for analysis of significance. ResultsThe response rate among the Finnish prehospital personnel was 66/70 (94.2%) while among the Swedish personnel it was 127/634 (20.0%). The prehospital personnel from Sweden showed significantly more Hesitation to administer pain relief compared to the Finnish personnel (mean 2.01 SD 0.539 vs. 1.67 SD 0.530, p<0.001). Those who had received pain education at their workplace showed significantly less Hesitation than those who had not participated in education. There was a significant negative correlation (p<0.01) between Hesitation and Side effects. There was also a statistically significant (p<0.01) correlation between Perceptions and Hesitation, indicating that a stoic attitude towards pain was associated with indifference to possible Side effects of pain medication (p<0.05). ConclusionsThe results show that there was a significant correlation between the extent of education and the prehospital personnel's attitudes to pain management. Gender and age among the prehospital personnel also affected the attitudes to pain management. The main discrepancy between the Swedish and Finnish personnel was that the participants from Stockholm showed statistically significantly more hesitation about administering pain medication compared to the participants from Helsinki. ImplicationsThe results of the study highlight the need for continuous medical education (CME) for prehospital personnel. CME and discussions among prehospital personnel may help to make a change in the personnel's attitudes towards pain and pain management in the prehospital context.

German ambulatory care physicians' perspectives on continuing medical education—A national survey

This survey aimed to investigate German ambulatory physicians' opinions about mandatory continuing medical education (CME) and CME resources shortly before the introduction of mandatory CME in 2004. A structured national telephone survey of general practitioners and specialists was conducted. Main outcome measures were opinions about mandatory CME, preferred CME media, and financial aspects of CME. Data analysis applied Pearson's correlation coefficient for explorative analysis of correlations, analysis of variance for group comparison, and chi(2)-test for investigation of distribution of 2 or more categorical variables. Of the 511 participants, 73% felt that CME supported them in keeping up to date with new medical knowledge, yet only half believed in its ability to minimize medical errors or increase quality of patient care. Traditional ways of learning were preferred. Significant differences in CME behavior were found between primary-care physicians and specialists, the latter using more communicative media. Also, a small group of very skeptical physicians who do not agree with the need for CME in general was identified. Average expenditure for CME was estimated between 500 and 1000 Euros per year. A majority of physicians called for other parties, eg, health insurances or government, to share the financial responsibility for CME. Mandatory CME was accepted as a necessity already before the new legislation took effect, with prevailing skepticism at the same time. Future research is needed on how to motivate physicians and especially certain subgroups of physicians to use CME methods shown to be effective in changing clinical behavior.

Fachärztliche Depressionsbehandlung – subjektive Wahrnehmung der Versorgungssituation und erlebte Barrieren

To analyse the status quo of depression treatment (procedure, responsibilities, and treatment barriers) from psychiatrists' point of view. Cross-sectional survey (n = 71 psychiatrists; return rate: 45.5 %). Diagnostic and therapeutic knowledge were validated as good. Psychiatrists view their responsibility mainly in identifying depressed patients, in differential diagnosis and medical treatment. The clinical diagnosis corresponded only in 52.7 % to ICD-10 criteria. Pharmacotherapy and referral were according to guidelines. Psychiatrists were less satisfied with cooperation with the psychosocial sector (social service, counselling centres) than with family physicians, psychotherapists and hospitals. The need for continuous medical education was seen specifically regarding therapeutic procedures (prophylaxis of relapse and combined therapy) and less concerning the diagnoses. The results affirm the quality outpatient psychiatric care of depressive patients. Improvement potentials regard evidence-based diagnostic and networking with the psychosocial sector.

Charter on continuing medical education/continuing professional development approved by the UEMS Specialist Section and European Board of Anaesthesiology*

The mission of the Section and Board of Anaesthesiology of the European Union of Medical Specialists (EUMS/UEMS) is to harmonize training and medical practice in all European countries to continuously improve the quality of care. The need for continuous medical education in the field of anaesthesiology has long been recognized. However, specialty-based competencies are not the only requirements for successful medical practice. The need to acquire medical, managerial, ethical, social and personal communication skills on top of specialty-based competencies has developed into the principle of continuous professional development, which embraces both objectives. The Section and Board of Anaesthesiology of the EUMS/UEMS has approved a proposal of its Standing Committee on Continuous Medical Education/Continuous Professional Development to adopt the following charter on the subject.

Post-thyroidectomy metastatic thyroid cancer

The objective of this paper is to highlight the importance of tissue biopsy for histopathological diagnosis. A report of a 46-year-old farmer with post-thyroidectomy metastatic thyroid cancer. A post-thyroidectomy patient presenting with extensive skull and lumbar spine metastasis, paraparesis, huge occipital swelling and good healed scar without tumour residue. The thyroidectomy specimen was not subjected to histopathological diagnosis. Fine needle aspiration cytology of the occipital swelling revealed metastatic follicular carcinoma. Patient was placed on thyroxine 0.5mg daily with great improvement of lower limb muscle power. These bony metastases could have been reduced if proper investigation was done. There is need for continuous medical education for all clinical medical personnel.

Guidelines by the European Federation of Neurological Societies (EFNS) subcommittee for Continuing Medical Education (CME) – modification 2003

Guidelines by the European Federation of Neurological Societies (EFNS) subcommittee for Continuing Medical Education (CME) – modification 2003