title: Diagnostic accuracy and the observation option in acute otitis media: the Capital Region Otitis Project.
abstract: OBJECTIVE
  Studies of acute otitis media indicate that deferring antibiotics in selected patients is a valid option. This study sought to determine the effects of a multifaceted educational intervention on disease management and treatment attitudes in practitioners caring for acute otitis media (AOM).
  
  
  METHODS
  An expert committee composed of clinical and public health practitioners was convened which reviewed current evidence-based literature on diagnosis and treatment of AOM. A survey instrument to measure attitudes was fashioned and administered to 150 invited practitioners before and after a daylong educational intervention. The intervention was composed of two diagnostic otoscopy workshops; a lecture on an antibiotic-centered approach to treatment, followed by a lecture on the Dutch "observation without antibiotic option" (OWAO), which in 1998 involved withholding antibiotic prescription for selected patients over the age of 2 for up to 72 h; and a concluding "Miller Interactive Process"--small group sessions on five key clinical management questions.
  
  
  RESULTS
  Significant short-term changes occurred in practitioners' attitudes in importance of ear pulling as a diagnostic symptom (P = 0.034) and clinical findings in the tympanic membrane for the diagnosis of AOM (P = 0.006). Significant changes towards increased comfort of practitioners' management attitudes were found in managing selected patients without antibiotics (P = 0.057), using shortened courses of antibiotics (P = 0.001), and using high dose amoxicillin (80 mg/kg/day) as a second line drug (P = 0.001).
  
  
  CONCLUSIONS
  Practitioners' attitudes about managing AOM can be modified in the short-term with an educational intervention combining didactic, hands-on, and interactive learning that incorporates evidence-based medicine.
authors.affiliation: School of Public Health, State University of New York at Albany, USA. gurnaney@mailcity.com
authors.forename: Harshad
authors.initials: H
authors.lastname: Gurnaney
authors.forename: Denise
authors.initials: D
authors.lastname: Spor
authors.forename: Delaney Greene
authors.initials: DG
authors.lastname: Johnson
authors.forename: Richard
authors.initials: R
authors.lastname: Propp
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D003625:Data Collection; D003939:Diagnostic Techniques, Otological; D019317:Evidence-Based Medicine; D006801:Humans; D009518:New York; D010033:Otitis Media / Q000175:diagnosis* / Q000628:therapy*; D010818:Practice Patterns, Physicians'
chemical_list: D000900:Anti-Bacterial Agents