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Background: The opportunities for continuing education among general practice (GP) assistants vary because of their dependence on their employers' attitudes and interests. Not all available continuing education activities are equally effective. The purpose of this study was to describe GP assistants' use of a range of quality improvement and continuing education activities, especially with regard to how much time was spent on each activity and how often the activities were used., Material and Methods: A questionnaire was sent to GP assistants in 1321 general practices., Results: 948 GP assistants returned the questionnaires. They spent on average one hour per week on continuing education. The primary activities were discussions with colleagues (daily), and meetings with pharmaceutical industry representatives (weekly). The use of courses was relatively modest; more than half of them were organised by pharmaceutical companies. Learning something new, improving practice and personal development were the most important motives for participating in continuing education., Interpretation: The opportunities for continuing education available to GP assistants vary a great deal and are to a large extent left to the pharmaceutical industry. Many if not most of the opportunities available cannot be expected to lead to changes in practice. Those responsible for general practice - GPs as well as the health authorities--should ensure that GP assistants have a wider and better range of options for continuing education.

Background: Many guidelines are not developed from systematic models and are not based on high-quality evidence. The existence of a guideline does not in itself lead to changes in practice and many guidelines are not used once they have been issued., Material and Methods: A questionnaire on continuing education and the use of guidelines was sent to 1500 general practitioners (GP) and GP assistants in 1321 general practices in Norway. 857 GPs and 948 GP assistants returned the questionnaire., Results: There was a large variation in the extent to which guidelines were known and used. Many GPs and GP assistants had little knowledge of guidelines published in the Journal of the Norwegian Medical Association or by the Norwegian Medicines Agency, the Norwegian Board of Health or the Norwegian Centre for Health Technology Assessment. There were exceptions: 52% of GPs used the Norwegian College of General Practitioners' treatment programme for diabetes and 77% of GP assistants used the Norwegian quality assurance programme for laboratory services in primary care., Interpretation: Guidelines should be based on the best available evidence but this in itself is not enough to ensure that they are adhered to. Effective strategies for implementation are also important.

Background: Continuing education should ensure that a doctor provides effective care based on the best available evidence. But not all continuing education is equally effective., Material and Methods: A questionnaire on continuing education was sent to 1500 general practitioners (GPs) in Norway. The response rate was 58%., Results: GPs spent on average 2.3 hours per week on continuing education. Discharge reports were used daily for continuing education by 75% of GPs and represented 10% of the total time spent on continuing education in a 30-day period. Courses were not used so often but took up a lot of time when attended. Traditional lectures accounted for 80% of course instruction. Learning something new and improving practice were the two most important objectives for participating in continuing education. Around every second GP participated in a small group of colleagues., Interpretation: GPs spend a lot of time on continuing education activities that research has shown to have little or no effect on practice. It is essential that the activities used are evaluated to a much greater extent than what they are now.

Background: Available guidelines for the diagnosis and treatment of sore throat give conflicting recommendations. Our aim was to develop evidence-based guidelines., Material and Methods: We searched The Cochrane Library, Medline and other sources for systematic reviews and other evidence that met explicit inclusion criteria for all of the relevant options and outcomes we identified. The validity of included studies was assessed. Draft recommendations based on assessment of this evidence were widely circulated and discussed in focus groups with patients and physician assistants., Results: Throat infections are self-limiting and complications rare. Penicillin shortens the duration of symptoms in tonsillitis caused by beta-haemolytic streptococci and reduces the risk of complications. Penicillin has adverse effects and increases the risk of reinfections. Patients with sore throat should usually be treated without antibiotics. Visiting a physician is normally unnecessary. Antibiotics should be considered in serious cases or if the patient prefers this, but should only be prescribed for throat infections caused by beta-haemolytic streptococci. The diagnosis should be based on clinical criteria and a rapid antigen test in cases of doubt., Interpretation: Benefits of antibiotics must be weighed against harms. Patients should be given good information and involved in decision/making if they want antibiotics.

Background: Available guidelines for the diagnosis and treatment of sore throat give conflicting recommendations. Our aim was to develop evidence-based guidelines., Material and Methods: We searched The Cochrane Library, Medline and other sources for systematic reviews and other evidence that met explicit inclusion criteria for all of the relevant options and outcomes we identified. The validity of included studies was assessed. Draft recommendations based on assessment of this evidence were widely circulated and discussed in focus groups with patients and physician assistants., Results: Throat infections are self-limiting and complications rare. Penicillin shortens the duration of symptoms in tonsillitis caused by beta-haemolytic streptococci and reduces the risk of complications. Penicillin has adverse effects and increases the risk of reinfections. Patients with sore throat should usually be treated without antibiotics. Visiting a physician is normally unnecessary. Antibiotics should be considered in serious cases or if the patient prefers this, but should only be prescribed for throat infections caused by beta-haemolytic streptococci. The diagnosis should be based on clinical criteria and a rapid antigen test in cases of doubt., Interpretation: Benefits of antibiotics must be weighed against harms. Patients should be given good information and involved in decision-making if they want antibiotics.

Background: Available guidelines for the management of symptoms of lower urinary tract infections (UTI) in women give conflicting recommendations., Material and Methods: We searched The Cochrane Library, Medline and other sources for evidence that met explicit inclusion criteria for the relevant options and outcomes identified. The validity of included studies was assessed. Draft recommendations were widely circulated and discussed in focus groups with patients and physician assistants., Results: The probability that a woman with dysuria or frequency has bacteriuria, is 80%. The probability of UTI given a negative result of a dipstick test is 50%. Evidence suggests that antibiotics will rapidly relieve symptoms, but there are limited data from placebo-controlled randomised trials. Population based studies show that many women do not visit physicians for symptoms of UTI. Women with symptoms of UTI can be treated with antibiotics without examination of the urine. Women with earlier episodes of UTI can be offered treatment by telephone. Antibiotics for three days is sufficient based on eradication of bacteriuria. Women should be seen by a physician if the symptoms are atypical., Interpretation: Implementing these guidelines could result in better service to women with UTIs. More evidence about the effects of antibiotics and other treatments is needed.

Health service users need reliable information to be able to make informed decisions. We evaluated the scientific quality of information presented at a large health fair in Oslo in 1995 and health-related articles in five newspapers during one week in the spring of 1995. The brochures scored consistently low on the index used to measure scientific quality. It was generally impossible to distinguish opinions from facts, or to assess the validity and consistency of the evidence underlying the conveyed information. Important consequences (benefits, risks and costs) were rarely assessed. Health-related articles in the lay press also scored low on the index. Minor changes could have led to marked improvement of some of the articles. It is important to improve the ability of journalists and producers of brochures to appraise their work in a critical light.