RESUMO
OBJECTIVE: To determine whether the Optic Neuritis Treatment Trial (ONTT) results have altered the practice patterns of ophthalmologists and neurologists. DESIGN: Mail survey. PARTICIPANTS: A random sample of 987 ophthalmologists and 900 neurologists practicing in the United States were mailed a questionnaire that inquired into decision-making with regard to management of optic neuritis before and after the publication of the ONTT results. MAIN OUTCOME MEASURES: Responses received from 202 ophthalmologists and 244 neurologists, a response rate of 47%. RESULTS: Following the ONTT reports, nearly all ophthalmologists and neurologists have reduced their use of oral prednisone alone, substituting a regimen that includes intravenous methylprednisolone. A large proportion of practitioners in both specialties mistakenly believe that intravenous methylprednisolone treatment improves final visual outcome. Only 7% of neurologists and 36% of ophthalmologists (P = 0.0001) are adhering to the ONTT suggestion to use magnetic resonance imaging as a basis for initiating treatment. CONCLUSIONS: The ONTT has led to a dramatic reduction in the use of oral prednisone without a preceding course of intravenous methylprednisolone in the treatment of acute optic neuritis. Ophthalmologists and neurologists have changed some of their practices without fully understanding the results of the ONTT.
Assuntos
Glucocorticoides/uso terapêutico , Neurologia/normas , Oftalmologia/normas , Neurite Óptica/tratamento farmacológico , Padrões de Prática Médica/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Administração Oral , Encéfalo/patologia , Tomada de Decisões , Humanos , Injeções Intravenosas , Imageamento por Ressonância Magnética , Metilprednisolona/uso terapêutico , Neurologia/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Neurite Óptica/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Prednisolona/uso terapêutico , Inquéritos e QuestionáriosRESUMO
From the perspective of an academic medical community in the United States, factors driving the increase in medical information on the Internet are examined. These factors are considered in two categories: those that create a demand for information, and those which respond to that demand or attempt to increase or profit by it. The factors explored include demographic, economic, and technological conditions on both sides of the information marketplace. The paper also addresses the responsibilities shared by providers of this information, and possible strategies to assure high-quality resources and informed use of them, both by health care professionals and by patients. The value of informed use is perhaps best conveyed with the following quote.