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Research indicates that traditional CME is not effective in changing performance. Multifaceted interventions are needed to change performance. The progressively growing medical knowledge and changing demands on the society form an ethical obligation for all doctors to update there knowledge and skills, but also to perform in practice according to what they have learned. Traditional CME has to be enriched with assessment of one’s own work and practice performance to identify the real learning needs, a concrete learning plan has to be formed and followed to achieve continuous professional development. A desired change in performance is the objective of any learning process. The EURACT CME/CPD –Committee (Continuing Medical Education/Continuous Professional Development) has developed this model workshop. Participants first identify their learning needs in practice using qualitative tools, make their own learning agenda and develop a concrete plan for learning, reviewed by colleagues. As tools in this workshop we will use consultation diary, self-reflection of competence using position mapping and significant event analysis, As a result of this workshop, the participants will understand some basic concepts of continuing professional development, as planned and peer-reviewed learning agenda based on identified learning needs. They will be able to use the introduced tools and methods in their own practice and in the training of others.

Research indicates that traditional CME is not effective in changing performance. Multifaceted interventions are needed to change performance. The progressively growing medical knowledge and changing demands on the society form an ethical obligation for all doctors to update there knowledge and skills, but also to perform in practice according to what they have learned. Traditional CME has to be enriched with assessment of one’s own work and practice performance to identify the real learning needs, a concrete learning plan has to be formed and followed to achieve continuous professional development. A desired change in performance is the objective of any learning process. The EURACT CME/CPD –Committee (Continuing Medical Education/Continuous Professional Development) has developed this model workshop. Participants first identify their learning needs in practice using qualitative tools, make their own learning agenda and develop a concrete plan for learning, reviewed by colleagues. As tools in this workshop we will use consultation diary, self-reflection of competence using position mapping and significant event analysis, As a result of this workshop, the participants will understand some basic concepts of continuing professional development, as planned and peer-reviewed learning agenda based on identified learning needs. They will be able to use the introduced tools and methods in their own practice and in the training of others.

The estimated number of heavy consumers of alcohol is about 20 percent of population, of which 10 percent suffer from alcohol dependency. Many heavy consumers of alcohol also smoke. The effectiveness of treatments can be significantly improved with medical treatment. The problems are: how medical treatment can be utilized in practical treatment, and how to ensure treatment adherence. The aim of this study was to investigate the effectiveness of pharmacotherapies combined with a brief manual-based cognitive-behavioural intervention (CBT) in treating alcohol-dependent patients. In the large-scale clinical treatment study, which ran for 2.5 years, the effectiveness and patient response to the three drugs (naltrexone, acamprosate and disulfiram) were compared. The study used a survey drawn up guidebook for patients, Winning at last defeating the drinking problem. In addition, we researched how the reduced alcohol consumption affects the quality of life, mood and smoking. In the study of sweet preference we analyzed possible associations between sweet preference and efficacy of naltrexone treatment. In addition, we researched patients treatment adherence and medication adherence to targeted naltrexone, as well as reduction of problem drinking and craving. This combined treatment (medication and CBT) significantly reduced alcohol consumption resulting in improved quality of life. Noticeable is that compared to the other study medicines, especially during the continuous medication period, supervised disulfiram appeared superior. During the targeted medication period, there were no other significant differences between the groups except for that the abstinence days were significantly more frequent in the disulfiram group. The treatment was also associated with success in quitting smoking among patients using disulfiram. The study of sweet preference, it was significantly related to treatment measures in the naltrexone group when the outcome was relapses to heavy drinking. Our study offers a possible new explanation of the clinical observation that naltrexone is not effective for every patient. Adherence to the targeted use of naltrexone added treatment compliance and efficacy of the medicine. Patients who had less symptoms of alcohol dependence, suffered from high craving for alcohol, were unemployment, young or could not keep the drinking diary were less committed to treatment. Problem drinking can be changed to abstinence or moderate drinking with the combination of medical therapy, CBT and good treatment commitment. The benefits of treatments are probably long-term, because part of the positive results lasted over two years. The treatment methods used in this study were usable and they can be implemented in all levels of Finnish health care. Alkoholin ongelmakäyttäjiä arvioidaan Suomessa olevan noin 20 prosenttia ja alkoholiriippuvaisia noin 10 prosenttia. Usein alkoholin liikakäyttöön liittyy myös tupakointi. Ongelmina ovat olleet lääkkeiden vähäinen käyttö käytännön työssä, sekä heikko hoitoon sitoutuminen. Tämän tutkimuksen päätavoitteena oli tutkia yhdistelmähoidon (lääkitys ja kognitiivinen käyttäytymisterapia) tehoa alkoholiriippuvuuden hoidossa terveyskeskuksissa, työterveydenhuollossa ja A-klinikoissa. Hoitotutkimuksessa, jonka kokonaiskesto oli 2.5 vuotta, vertailtiin kolmea alkoholiriippuvuuden hoitoon tarkoitettua lääkettä (naltreksoni, akamprosaatti tai disulfiraami). Lisäksi käytettiin tähän tutkimukseen laadittua, kognitiiviseen käyttäytymisterapiaan perustuvaa, potilaalle tarkoitettua opaskirjaa: Voittajana Perille . Lisäksi selvitettiin alkoholin kulutuksen vähenemisen vaikutusta elämänlaatuun, mielialaan sekä tupakointiin. Naltreksonilääkityksen tehoon vaikuttavia tekijöitä tutkittiin selvittelemällä makeamieltymyksen vaikutusta hoidon onnistumiseen. Lisäksi selvitettiin potilaiden sitoutumista hoitoon, ja tarvittaessa otettavan naltreksonin käytön tunnollisuutta sekä juomishimon vähenemistä. Tutkimukset osoittivat, että potilaat, jotka käyttivät yhdistelmähoitoa, vähensivät merkitsevästi alkoholin käyttöään ja heidän elämänlaatunsa parani. Disulfiraami oli tehokkaampi kuin muut tutkimuksessa käytetyt lääkkeet vähentämään runsasta juomista, juomisen aloittamista, viikoittaista alkoholinkulutusta sekä lisäämään raittiiden päivien määrää säännöllisen lääkityksen aikana (3 kk), ja tarvittaessa otettavan lääkekäytön (lääke otetaan, jos riski juomisen aloittamiseen on suuri) aikana (9 kk), mutta ryhmien väliset erot alkoivat tasoittua 6 kk kohdalla. Lisäksi osoitettiin, että disulfiraamilääkkeellä voisi olla vaikutusta tupakoinnin lopettamiseen. Makeamieltymyksen ja naltreksonin tehon välillä pystyttiin osoittamaan yhteys. Naltreksoni tehosi paremmin, jos oli mieltynyt makeaan. Ero makeamieltymyksessä saattaa olla yksi selitys sille, miksi naltreksoni ei näyttäisi tehoavan kaikille alkoholiongelmaisille. Naltreksonilääkkeen ottaminen vain tarvittaessa lisäsi hoitoon sitoutumista ja lääkkeen tehoa. Huonoimmin hoitoon sitoutuivat potilaat, joilla oli enemmän alkoholiriippuvuuden aiheuttamia oireita, vahva alkoholin himo, jotka eivät kyenneet pitämään juomapäiväkirjaa, sekä työttömät ja nuoret potilaat. Alkoholiriippuvuuden haittoja voi vähentää lääkehoidon, kognitiivisen käyttäytymisterapian ja hyvän hoitoon sitoutumisen avulla. Hoidosta saatava hyöty on todennäköisesti pitkäaikainen, koska osa myönteisistä tuloksista säilyi yli kaksi vuotta. Tässä tutkimuksessa käytetty hoito-ohjelma on selkeä ja mahdollisia toteuttaa suomalaisessa terveydenhuollossa.