Spirometry is the widely used method in clinical practice in different levels of medical care. Sometimes it is use as the screening method in general practice, bus very often as the method in diagnostic procedures for asthma diagnosis, chronic obstructive pulmonary diseases, and restrictive pulmonary syndromes and so on. Very often spirometry is used as the part of diagnostic protocols for asthma treatment follow up, and many other respiratory diseases. Diagnostic procedures for asthma diagnosis sometimes include bronchoprovocation testing using methacholine or some other chemical bronchoconstrictive agents. Patients own experience for diagnostic procedures may influence to results of procedure. Experienced patients could have very well results, but they could perform very worse result so. Inexperienced patients perform worse results and that result should not be considered for diagnosis of therapeutic follow up. Medical staff, involved in spirometric procedures can influence so much, by explanation of spirometric procedures and giving support for the patients. How to assess the quality control we discuss in this paper. Background: Timely knowledge transfer and intervention is crucial for controlling emerging and re-emerging infections. This study evaluates the impact of knowledge transfer and intervention in selected group of previous disease outbreaks in the United States, reveal weaknesses and missed opportunities and extract lessons for future practice. Methods: Seventeen disease outbreaks that occurred during 1900-2007 were selected based on availability of information relevant for completing this study. Data and time line of events pertaining to the onset, progress and control of each outbreak were extracted through a careful review and synthesis of the literature. The study was carried out from May to September 2007. Results: Median length of time between the onset and definitive diagnosis was 30 days for outbreaks that occurred before 1990 and 7.5 since 1990 (p=0.09). The corresponding values till recognition were 90 and 18.5 days, respectively (p= 0.04). The median number of days till the peak of the outbreak was 135 days before 1990 and 20.5 since 1990 (p=0.024). For outbreak signals reported by clinicians the median number of days for definitive diagnosis was 4 as compared to 30 for alternative sources (p=0.015). The corresponding values till recognition was 15 and 52.5, respectively (p=0.025). There was a positive correlation between the number of deaths and the number of days taken to recognize an outbreak (0.016). Conclusion: Considering the significance and benefits of direct reporting by clinicians to public health authorities, clinicians should receive higher standards of training in identification, reporting, prompt response, control and interventions during disease outbreaks.
Key words: Disease, Outbreaks
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