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Rationale, aims and objectives Traditional continuing medical education programmes that offer passive learning have been shown to be poorly effective at changing doctors' clinical behaviour. A multifaceted evidence-based medicine (EBM) intervention was conducted at the largest health maintenance organization (HMO) in Israel, attempting to facilitate a change in doctors' attitudes, knowledge and clinical behaviour. No study thus far has examined the association between the teaching of EBM principles and doctors' clinical behaviour. This study evaluated the intervention programme through a controlled trial and before and after study. The objective of the evaluation is binary: first, to examine the impact of an educational intervention on family doctors' test ordering performance and drug utilization by their patients; and second, to assess the impact of the intervention on attitudes towards evidence-based practice and knowledge. Methods Controlled trial and before and after study. Primary care clinics comprising similar patient characteristics were randomly allocated to the experimental or to the control group. Doctors in the experimental group participated in an EBM educational intervention, while the control group did not take part in the intervention. Clinicians' test ordering performance and their patients' drug utilization were derived from the HMO's database before intervention, after workshops and after intervention. Participants in the controlled trial consisted of 75 doctors and their 106 349 patients. The before and after study evaluated intervention doctors' ( n = 70) EBM attitudes and knowledge through a validated questionnaire before and after workshops. Results EBM workshops enhanced intervention doctors' EBM knowledge scores from 22.4/100 before workshops to 40.8/100 after workshops ( P = 0.000). Doctors improved their ability to formulate clinical questions while enhancing their search strategy using Medline. In a linear regression model, two covariates, specialization (B = 12.59; P = 0.001) and habitually reading medical journals (B = 6.45; P = 0.052), best explained the variance in doctors' EBM knowledge scores, while controlling for pre-intervention scores (R 2 = 0.569; P = 0.000). Results from the controlled trial indicated that no statistically significant differences were found between intervention and control doctors' test ordering performances, and their patients' drug utilization. Conclusions The results of the study suggest that the intervention positively influenced attitudes and knowledge; however, no statistically significant impact was found on doctors' test ordering performance and on their patients' drug utilization. The intervention's inability to change doctors' clinical behaviour might be remedied by improving future interventions through adding additional facets to the educational intervention, such as social marketing techniques and personal feedback. A longer and more extensive intervention might be more effective but is extremely difficult to execute as we found in this study. Future larger-scale interventions must incorporate the intervention into the routines of the organization, thus minimizing barriers towards EBM implementation. [ABSTRACT FROM AUTHOR]

Purpose: Data regarding the recommended maximum duration that refrigerated medications available in hospital pharmacies may be stored safely at room temperature were collected and compiled in a tabular format., Methods: During May and June of 2006, the prescribing information for medications labeled for refrigeration as obtained from the supplier were reviewed for data addressing room-temperature storage. Telephone surveys of the products' manufacturers were conducted when this information was not available in the prescribing information. Medications were included in the review if they were labeled to be stored at 2-8 degrees C and purchased by the pharmacy department for uses indicated on the hospital formulary. Frozen antibiotics thawed in the refrigerator and extemporaneously compounded medications were excluded. Information was compiled and arranged in tabular format. The U.S. Pharmacopeia's definition of room temperature (20-25 degrees C [68-77 degrees F]) was used for this review., Results: Of the 189 medications listed in AHFS Drug Information 2006 for storage in a refrigerator, 89 were present in the pharmacy department's refrigerator. Since six manufacturers were unable to provide information for 10 medications, only 79 medications were included in the review. This table may help to avoid unnecessary drug loss and expenditures due to improper storage temperatures., Conclusion: Information regarding the room-temperature storage of 79 medications labeled for refrigerated storage was compiled.

Objectives: To evaluate both the safety and the costeffectiveness of the Home Intravenous Antibiotic Therapy (HIAT) program for the treatment of patients with osteomyelitis in the district of Haifa and Western Galilee., Methods: We checked the medical records of all the patients with osteomyelitis who had been treated at home with intravenous antibiotics during 1999-2000. We reviewed their records for etiological agents, types of antibiotics given, complications and cost evaluation., Results: During the two year period (January 1999 to December 2000), 52 patients received 55 courses of HIAT. The total duration of treatments was 1187 days. Eighty-five percent of the patients were referred from clinical departments from one of the medical centers in our area. In 54.6% of cases the infecting agent is unknown. Among the known ones, Staphylococci and Pseudomonas aeruginosa were the most prevalent pathogens. Penicillins and Cephalosporins were the most common antimicrobial agent prescribed. The HIAT program saved NIS. 1,299,765 (approx. $365,000) during 1999-2000. Only minor complications were present., Conclusions: HIAT for the treatment of patients with osteomyelitis is effective, safe and comfortable for the patients and has an important economic impact.