Increased access to up-to-date resources, both on-line and text, improved adherence to core

standards of practice, and improved confidence of providers is expected to translate to find more more consistent and better care for the international traveler who visits their GP surgery or private TM clinic, an important goal for the practice of TM.10,18,21,23,33 The major limitation of this study is that the response rate was lower than in the baseline study. It is not possible to quantify the selection biases present in this study, however, the distribution of YFVCs completing the questionnaire was representative of the complete database in terms of location, size, and type. As potential explanations for the lower response rate, the questionnaire was administered Palbociclib chemical structure when there were extensive demands upon health professionals caused by pandemic influenza, and response to the 2005 survey was obligatory if the center wished to continue practising as a YFVC. Questionnaires were completed anonymously and were not matched in the 2005 and 2009 surveys, meaning that results from this survey could

not be directly compared with the 2005 survey. While this limits the ability to measure improvements, anonymity was chosen to encourage YFVCs to respond and to complete the survey honestly. Despite this limitation, trends have been identified and discussed. There is also the question whether self-reporting is a valid tool for unbiased data capture. Improvements to clinical practice often begin with a

standard being implemented. Self-reporting is then used to assess compliance, with a more formal audit of practice based on these results. In person audits of YFVCs were not possible for this study given the resources available. However, on-line surveys can deliver comparable results to more traditional methods.34 A more detailed audit of clinical decision making is planned for all YFVCs in 2012. It is possible that other influences within the field of TM, such as availability of new resources, could have contributed to the observed improvements Pregnenolone in practice. However, the introduction of core standards by NaTHNaC, and the training and ongoing sources of support that NaTHNaC provide are likely to have improved YF practice in EWNI. Determining if adherence to standards translates to improved care in TM is an important research question. Only a few countries have established national programs for YF vaccination and, unlike the NaTHNaC program, most have not tied designation status to standards, education, and audit.20–22 With international efforts to improve the quality of care received in TM practice, a model such as that developed by NaTHNaC could be considered by other countries, as they aim to comply with the IHR (2005) request to designate specific YFVCs.