This Online Educational Resource Centre is Wonca's repository of educational material from a variety of sources.
It is proposed to place CME/CPD material in the Resource Centre progressively. Wonca is in the process of developing its own system of CME programs and credits for members. Watch this page for new content.
See also the Family Medicine Digital Resources Library (FMDRL), a service of the Society of Teachers of Family Medicine.
Its mission is: "To support and enhance the sharing and collaborative development of educational resources among family medicine educators through a Digital Library that includes resources for all levels of family medicine education." On FMDRL you'll find: Conference Presentations/Handouts, PowerPoint Lectures, Learning Modules, Digital Images, Recommended Web sites, Curricular Materials.
To view FMDRL, click here.
See also the new website of the
Global Alliance against Chronic Respiratory Diseases (GARD) at
www.who.int/gard
Index
Chronic Respiratory Diseases - a clinical series for family doctors
Taiwan Hand Washing Program
Guidelines for International Breast Health and Cancer Control
COPD exacerbations
Educational Resources on Tobacco
Time to Live - a new report on COPD
IPAG Diagnosis & Management Handbook - Chronic Airways Diseases, A Guide for Primary Care Physicians
CE Medicus - An educational experience for health care professionals
Clinical Nutrition Updates
Other educational resources
A subset of the Educational Resource Centre is a section on where classic papers are aggregated. To view this section,
click here. The latest paper to be added is
Primary Care Contributions to Health Systems and Health by Barbara Starfield, MD, MPH, The Johns Hopkins Primary Care Policy Center for the Underserved and The Johns Hopkins Bloomberg School of Public Health; Leiyu Shi, DrPH, MBA, The Johns Hopkins Primary Care Policy Center for the Underserved and The Johns Hopkins Bloomberg School of Public Health and James Macinko, PhD, Department of Nutrition, Food Studies, and Public Health, New York University.
To view it click here.
For online literature search facilities
click here.
For other educational resources
click here.
Chronic Respiratory Diseases - a clinical series for family doctors
Sponsored by MSD (Merck, Sharp & Dohme)
Smoking Cessation
Smoking cessation is the single most effective, and cost-effective, intervention to reduce the risk of developing COPD and slow its progression. Cigarette smoke is also a trigger for asthma and allergic rhinitis symptoms, and smoking cessation is an important component of managing these diseases.
Even a brief, 3-minute period of counseling to urge a smoker to quit can be effective, and at a minimum this should be done for every smoker at every visit. More intensive strategies increase the likelihood of sustained quitting.
Pharmacotherapy (nicotine replacement and/or buproprion) is recommended when counseling is not sufficient to help
patients stop smoking. Special consideration should be given before using pharmacotherapy in people smoking fewer
than 10 cigarettes per day, pregnant women, adolescents, and those with medical contraindications (unstable coronary
artery disease, untreated peptic ulcer, and recent myocardial infarction or stroke for nicotine replacement; and history of seizures for buproprion.
To learn more, click here.
COPD Management Track
Long-Term Therapy for Stable COPD
Therapy for COPD should follow a stepwise approach depending on the severity of the individual patient’s disease. For dosage, side effects, and other details about medications for COPD
click here. Details about rehabilitation and oxygen therapy and also instructions for the use of various inhaler and spacer devices, can be found in the Global Initiative for Chronic Obstructive Lung Disease Global Strategy for Diagnosis, Management, and Prevention of COPD, available from
http://www.goldcopd.org.
To learn more, click here.
Therapy For COPD Exacerbations
COPD is often associated with exacerbations, or worsening of symptoms such as cough, sputum production, and breathlessness. The cornerstones of management of COPD exacerbations are bronchodilators, glucocorticosteroids (in some patients), and antibiotics (when a bacterial cause is suspected).
Criteria for hospitalization include: marked increase in intensity of symptoms, such as sudden development of resting dyspnea; severe background COPD; onset of new physical signs, such as cyanosis or peripheral edema; failure to respond to initial treatment; significant comorbidities; newly occurring arrhythmias; diagnostic uncertainty; older age; insufficient home support.
For further information on treatment of COPD exacerbations, refer to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Global Strategy for Diagnosis, Management, and Prevention of COPD, available from
http://www.goldcopd.org.
To learn more, click here.
Severity Assessment
Once COPD is diagnosed, it should be classified as Mild, Moderate, Severe, or Very Severe based on the patient's symptoms and (post-bronchodilator) lung function. Where spirometry is not available, severity must be determined based on the patient’s symptoms and the level of activity of which he or she is capable.
Chronic cough and sputum production often precede the development of airflow limitation by many years, and therefore attention to patients who have these symptoms and are “At Risk” of COPD, but who do not yet have abnormal lung function, is important. However, not all individuals with cough and sputum production go on to develop COPD.
To learn more, click here.
Long Term Asthma Therapy - Adults
Asthma in adults is treated in a stepwise manner based on the severity of the disease. The number and frequency of medications increase (step up) as the need for asthma therapy increases, and decrease (step down) when asthma is under control. Use the table to help guide you to appropriate treatment for adults (over age 15) with asthma. Dosage, side effects, and other details about medications for asthma are found on page 23 of the IPAG Handbook. Instructions for the use of various inhaler and spacer devices are available online at
http://www.ginasthma.org.
To learn more, click here.
Long Term Asthma Therapy - Children
Asthma is treated in a stepwise manner based on the severity of the disease. The number and frequency of medications increase (step up) as the need for asthma therapy increases, and decrease (step down) when asthma is under control. Use the table to help guide you to appropriate treatment for children under age 5 with asthma. Dosage, side effects, and other details about medications for asthma are given. Instructions for the use of various inhaler and spacer devices are available online at
http://www.ginasthma.org. In young children, it is difficult to predict and regulate the need for reliever therapy, so more emphasis is placed on early introduction of daily controller treatment rather than reliance on “as-needed” rescue medications. Although in young children there is the possibility of overtreatment, episodes of wheezing may be shortened and reduced in intensity by the effective use of anti-inflammatory medications and bronchodilators rather than antibiotics. In addition to pharmacologic therapy, consider recommending influenza vaccination. Finally,children and carers should be advised about how to avoid exposure to risk factors or "triggers" (allergens and irritants, including cigarette smoke, that make asthma worse).
To learn more, click here.
Issue 9 Asthma Management Track
This section has two parts
Asthma Severity Assessment
Once asthma has been diagnosed, it should be classified as Intermittent, Mild Persistent, Moderate Persistent, or Severe Persistent based on the combined assessment of symptoms and lung function. The presence of any one of the features is sufficient to place a patient in the category.
Therapy For Asthma Attacks
Exacerbations of asthma (asthma attacks) are episodes of a progressive increase in shortness of breath, cough, wheezing, or chest tightness, or a combination of these symptoms. Initial treatment of an asthma attack involves increasing the dose of reliever medication (e.g., inhaled rapid-acting beta2-agonist up to 3 treatments in 1 hour). Oral glucocorticosteroids should be added in all but the mildest exacerbations.
For further information on treatment of asthma attacks, refer to the Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention, available at
http://www.ginasthma.org.
Click here for the ninth in the series.
Issue 8 Allergic Rhinitis Management Track
This section has three parts:
Allergic Rhinitis Severity Assessment
Once allergic rhinitis is diagnosed, it should be classified as to the pattern, frequency, and duration of symptoms (Intermittent or Persistent) and the severity and effect of symptoms on the patient’s daily life (Mild or Moderate-Severe).
Allergic Rhinitis Therapy
Pharmacologic treatment of allergic rhinitis depends on both the classification of severity and the individual patient’s symptoms. In patients with allergic rhinitis, use the figure to guide you to treatment options appropriate for the individual patient’s severity of disease.
Follow-up and Ongoing Care
Follow up as indicated in the figure. Consult the Allergic Rhinitis Medication Guide for details about therapy options. This section has five parts:
Click here for the eighth in the series.
Issue 7 - Management
This section has five parts
Overview of the IPAG Management Approach
Management of the patient with chronic airways disease in the primary care setting requires an assessment of the severity of the disease and its appropriate treatment based on evidence-based practice guidelines. Alternative therapeutic options need to be available.
Gathering the Clinical Database
For chronic airways diseases, a complete medical history should be taken, and physical and laboratory examinations performed, as reviewed in the Diagnosis Section.
Using the IPAG Management Aids
An algorithm will guide you through the management process when you have gathered the necessary clinical information.
Identify the Appropriate Management Track
Follow the algorithms based on the patient’s diagnosis and age:
Patients with Allergic Rhinitis: Proceed to Allergic Rhinitis Management Track. Follow red color-coded allergic rhinitis management materials.
Patients with Asthma: Proceed to Asthma Management Track. Follow blue color-coded asthma management materials.
Patients with COPD: Proceed to COPD Management Track. Follow gold color-coded COPD management materials.
Management Algorithm for Chronic Airways Diseases
Use the chart for patients who you believe have allergic rhinitis, asthma, or COPD.
Click here for the seventh in the series.
Issue 6 - COPD Diagnosis Track
This section has three parts:
COPD Questionnaire
To evaluate the possibility of COPD in adults age 40 and over who have ever smoked cigarettes AND who have no prior diagnosis of respiratory disease or current regular respiratory treatment, start by asking the questions in the questionnaire.
COPD Diagnosis Guide
In adults age 40 and over, whose responses to the COPD Questionnaire or Differential Diagnosis Questionnaire suggest that this diagnosis should be investigated, use this guide to help you evaluate the possibility of COPD.
Differential Diagnosis Questionnaire
To evaluate the possibility of asthma and COPD in adults age 40 and over who have never smoked OR who have a prior diagnosis of respiratory disease or current regular respiratory treatment, start by asking the questions in the differential diagnosis questionnaire.
Click here for the sixth in the series.
Issue 5 - Adult Asthma Diagnosis Track
This section has two parts:
Adult Asthma Questionnaire
To evaluate the possibility of asthma in adults age 15 and over, start by asking the questions in the questionnaire Given the intermittent nature of asthma symptoms, these questions may need to be asked repeatedly over time to establish the likelihood of asthma.
Adult Asthma Diagnosis Guide
In adults age 15 and over, whose responses to the Adult Asthma Questionnaire or Differential Diagnosis Questionnaire suggest that this diagnosis should be investigated, use this guide to help you evaluate the possibility of asthma.
Click here for the fifth in the series.
Issue 4 - Childhood Asthma Diagnosis Track
This section has three parts:
Early Childhood Asthma Diagnosis Guide
In children under age 6 with lower airways symptoms, use this guide to help you evaluate the possibility of asthma.
Childhood Asthma Questionnaire
To evaluate the possibility of asthma in children age 6-14, start by asking the questions in the questionnaire.
Childhood Asthma Diagnosis Guide
In children age 6-14, whose responses to the Childhood Asthma Questionnaire suggest that this diagnosis should be investigated, use this guide to help you evaluate the possibility of asthma.
Click here for the fourth in the series.
Issue 3 - Allergic Rhinitis Diagnosis Track
This section has three parts:
Allergic Rhinitis Questionnaire
To evaluate the possibility of allergic rhinitis, start by asking the questions in the questionnaire in the IPAG Handbook.
Allergic Rhinitis Diagnosis Guide
In patients of all ages with lower nasal symptoms only, whose responses to the Allergic Rhinitis Questionnaire suggest that this diagnosis should be investigated, use this guide (in the IPAG Handbook) to help you evaluate the possibility of allergic rhinitis.
Evaluation
If these diagnostic investigations and your clinical judgement support the diagnosis of allergic rhinitis, proceed to the Allergic Rhinitis Management Track on page 16 of the IPAG Handbook.
Click here for the third in the series.
Issue 2 - Preface to the IPAG Handbook - Chronic Airways Disease
Chronic airways diseases such as asthma, chronic obstructive pulmonary disease (COPD), and allergic rhinitis are a huge source of morbidity and mortality worldwide, and unlike most other categories of disease, which are decreasing in prevalence, chronic airways diseases are on the increase. There is a great need for more and better care of these diseases.
Primary care clinicians treat the vast majority of patients with chronic airways diseases in most countries. However, global evidence-based practice guidelines are often complicated and recommend the use of resources often not available in the primary care setting worldwide. As a result, primary care clinicians often believe that such guidelines cannot be followed in their practices.
However, management that follows evidence-based practice guidelines yields better patient results. Even when available resources do not permit 'ideal practice' care, appropriate management that is consistent with evidence-based practice guidelines and achievable with available resources can still be performed and improve patient care.
Click here for the second in the series.
Issue 1
On 28 March 28 2006, the WHO Global Alliance against Chronic Respiratory Diseases (GARD) was launched in Beijing. This global voluntary alliance of 41 national and international organizations in collaboration with WHO works on the prevention and treatment of the chronic respiratory diseases (CRD) that have a large impact on populations around the world. “The goal of GARD,” said Professor Jean Bousquet, GARD chairman, “is to reduce the global burden of CRD. We shall raise awareness on CRD and help to implement best practices, according to existing guidelines. As the prevalence and global burden of CRD are expected to increase considerably in the near future, it is clear that immediate action is greatly needed and the cost for inaction is unacceptable”. To see the GARD flyer, click here.
Wonca, as a founding member of GARD, was present in Beijing where it was decided that during the first years of the program priority would be given to asthma, allergy and in particular chronic obstructive pulmonary disease (COPD). The choice of Beijing for the GARD launch had everything to do with the fact that about a third of the people dying each year of COPD, are from China.
Later this year a full revision of the guidelines for COPD management prepared by GOLD (Global Initiative for Chronic Obstructive Lung Diseases) will be presented in Kyoto.
This is the first of a clinical series presented by Global Family Doctor - Wonca Online on Chronic Respiratory Diseases that will use as its prime resource the International Primary Care Airways Group 2005 IPAG Diagnosis and Mangaement Handbook.
This free document (in PDF format), is supported by an educational grant from MSD (Merck, Sharp & Dohme). To view it, click here.
For the index to this series, click here.
Taiwan Hand Washing Program - Teach hand washing in a fun and easy way
Designed for children, this program The Five Steps to Hand Washing is sponsored by McDonald's Corporation and Ronald McDonald House Charities. It is illustrated with images and text.
In 1997, following an outbreak of food borne illness that was traced to consumers not washing their hands prior to eating, McDonald’s Taiwan and Ronald McDonald House Charities Taiwan worked with the Taiwan Department of Health and our Member Organization in Taiwan to develop a hand washing awareness campaign. The hand washing procedures are based on McDonald’s crew hand washing guidelines, and were reviewed by the Department of Health and health experts in immunity. The result was a program that includes the five steps of hand washing. The familiar Ronald McDonald image on the initial page is to attract the attention of young people and draw them into the details of the program.
The Ronald McDonald House Charities, which has been running this very successful program in cooperation with our Taiwan member and the local Ministry of Health, has had a significant impact in reducing enteroviral infections. If any Member Organization would be interested in developing a similar program, please contact Wonca's CEO, Dr Alfred Loh, at ceo@wonca.com.sg to discuss possible avenues of support from, and cooperation with, the Ronald McDonald House Charities.
To view the introduction to the program, click here. You will exit the Global Family Doctor website and go to a website created by McDonald's to illustrate the Hand Washing Program.
To view the five steps of the program, click here.
Guidelines for International Breast Health and Cancer Control
Global Family Doctor - Wonca Online would like to bring to your attention the recent publication of the Guidelines for International Breast Health and Cancer Control in the January-February edition of The Breast Journal.
The publication is freely available on the internet on the Breast Health Global Initiative (BHGI) website at:
http://www.fhcrc.org/science/phs/bhgi/guidelines/publications.html
Is this your season for COPD exacerbations? Prevent Hospitalization
To review the guidelines for contemporary therapy of COPD exacerbations in the International Primary Care Airways Group January 2005 IPAG Diagnosis and Mangaement Handbook, click here.
To view the entire free document (PDF format) click here.
To view a free document (PDF format) on COPD exacerbation management written by two family doctor respiratory experts Thys van der Molen, and John Houghney, MD in November 2005, click here.
Wonca is involved in the care of chronic respiratory diseases. In Beijing in March, WHO will launch its GARD (Global Alliance against Chronic Respiratory Diseases) program. GARD comprises international organisations for respiratory medicine including Wonca. Later this year a full revision of the guidelines for COPD management prepared by GOLD (Global Initiative for Chronic Obstructive Lung Diseases) will be presented in Kyoto.
Educational Resources on Tobacco
The Wonca Special Interest Group on Health Behaviour Change has compiled a list of informative websites for family doctors on tobacco cessation and tobacco control.
To view this educational resource, click here.
Time to Live - a new report on COPD
The authors of Time to Live, Drs Haughney and van der Molen, are family doctors with significant expertise in respiratory care. They believe that enormous benefit will result if a greater effort is made to diagnose and treat patients with COPD exacerbations. They have prepared the Time to Live document to help family doctors accomplish this valuable goal and have asked Wonca to assist them in disseminating this information to family doctors worldwide. The document has helpful advice about the diagnosis of COPD exacerbations as well as clear and straight-forward advice about its management that is consistent with the IPAG Handbook for family doctors as well as with the evidence-based GOLD guidelines for COPD.
Following peer-review input and approval, this document is now being made available via GFD. In addition, there has been a press release about the document that also brings out its important insights concerning COPD patients and their deepest concerns about the disease, which will help family doctors in their management. We acknowledge the educational grants of AstraZeneca, a worldwide leader in respiratory therapy, for the development and dissemination of this document.
See the Executive Summary and Contents of Time to Live click here.
To exit Global Family Doctor and go to the full Time to Live Report on a separate web page where you will be able to view and print the document, click here.
IPAG DIAGNOSIS & MANAGEMENT HANDBOOK
Chronic Airways Diseases
A Guide for Primary Care Physicians
International Primary Care Airways Group (IPAG), January 2005
Chronic airways diseases such as asthma, chronic obstructive pulmonary disease (COPD), and allergic rhinitis are a huge source of morbidity and mortality worldwide, and unlike most other categories of disease, which are decreasing in prevalence, chronic airways diseases are on the increase. There is a great need for more and better care of these diseases. This Handbook is designed to assist primary care physicians to provide that care.
It is made available free to Global Family Doctor users, supported by an educational grant from Merck.
To view it, click here.
CE Medicus™ is a rich repository of case-based clinical problems for health professionals that has been made available as a free educational service to Wonca and Global Family Doctor users. CME credits may be available after successful completion of designated programs. Check with your licensing board, local regulatory body or college/academy to determine if they will accept ACCME statements of credit for their CME.
Click here to learn more about CE Medicus.
The Arbor Clinical Nutrition Updates - the world's most widely read nutrition publication for health professionals - is now available to Wonca members. The Updates provide a regular, concise review of the latest findings in clinical nutrition from a doctor's perspectivet.
The Editor-in-Chief is a family physician, educator and nutritionist (Dr Tony Helman). With an Editorial Board of many of the world's leading nutrition experts (and Wonca's own Dr Wes Fabb) the Arbor Clnical Nutrition Updates are the premier source of nutrition information for practising clinicians. The Updates are published in 9 languages (English, Spanish, Portuguese, French, Italian, Russian, Korean, Turkish and Japanes), with over 100,000 health professional readers in 187 countries.
For more information on the Updates click here.
For other educational resources click here.
