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At least 721 records · Page 40Linked to original sources
PubMed2002

Unexplained extra visits to general practitioners before the diagnosis of first urinary tract infection: a case-control study.

AIMS: To determine: (1) whether children diagnosed with a urinary tract infection (UTI) visited their general practitioner (GP) more frequently before the diagnosis of UTI was established compared to children never diagnosed with a UTI; and (2) whether those children with evidence of renal scarring at their first diagnosed UTI visited their GPs more frequently before diagnosis compared to children who did not have evidence of renal scarring when their first UTI was investigated. METHODS: Case-control study of 77 children with a UTI identified from a hospital radiology database (37 with and 40 without renal scarring), and 77 age, sex, and general practice matched controls. Main outcome measures were entries in general practice clinical records for types of illness, antibiotic prescriptions, and urine samples requested prior to the diagnosis of first UTI (cases) or equivalent time periods for controls. RESULTS: Cases had a mean 2.94 additional visits or 21% more visits (95% CI 1% to 41%) in the period (mean 2.4 years) prior to the visit at which their first UTI was diagnosed, including a mean 2.5 additional visits or 23% more visits for infectious illness (95% CI 1% to 45%). The cases had 114% (95% CI 41% to 184%) more visits for symptoms relating to the genitourinary tract, though the actual number of these visits was small. They were febrile at 49% more visits (95% CI 1% to 99%) and received significantly more courses of antibiotics than controls (5.2 v 4.1). They had more urine samples requested (37 v 3). Both the cases with and without renal scarring had similar excess GP visits. CONCLUSION: Compared to controls, children diagnosed with a first UTI had more visits at which symptoms of infection were recorded and more antibiotics prescribed prior to the visit at which the first UTI was diagnosed. These excess visits may have included undiagnosed UTIs. Both those with and without renal scarring had a similar degree of excess visits; additional aetiological factors must have played a role in scar formation.

Anti-Bacterial Agents↗
PubMed1991

Self-monitoring: the patient-practitioner alliance.

Self-monitoring of blood glucose (SMBG) is an essential component of the therapeutic regimen in diabetes management and new technology offers a variety of options for patients and practitioners. This article presents guidelines for appropriate use of SMBG in persons with diabetes and a discussion of quality assurance and infection control issues. A strong patient-practitioner alliance encourages compliance and supports the maximum use of information obtained by SMBG.

Blood Glucose Self-Monitoring↗
PubMed2005

Procalcitonin-guided antibiotic use versus a standard approach for acute respiratory tract infections in primary care: study protocol for a randomised controlled trial and baseline characteristics of participating general practitioners [ISRCTN73182671].

BACKGROUND: Acute respiratory tract infections (ARTI) are among the most frequent reasons for consultations in primary care. Although predominantly viral in origin, ARTI often lead to the prescription of antibiotics for ambulatory patients, mainly because it is difficult to distinguish between viral and bacterial infections. Unnecessary antibiotic use, however, is associated with increased drug expenditure, side effects and antibiotic resistance. A novel approach is to guide antibiotic therapy by procalcitonin (ProCT), since serum levels of ProCT are elevated in bacterial infections but remain lower in viral infections and inflammatory diseases. The aim of this trial is to compare a ProCT-guided antibiotic therapy with a standard approach based on evidence-based guidelines for patients with ARTI in primary care. METHODS/DESIGN: This is a randomised controlled trial in primary care with an open intervention. Adult patients judged by their general practitioner (GP) to need antibiotics for ARTI are randomised in equal numbers either to standard antibiotic therapy or to ProCT-guided antibiotic therapy. Patients are followed-up after 1 week by their GP and after 2 and 4 weeks by phone interviews carried out by medical students blinded to the goal of the trial. Exclusion criteria for patients are antibiotic use in the previous 28 days, psychiatric disorders or inability to give written informed consent, not being fluent in German, severe immunosuppression, intravenous drug use, cystic fibrosis, active tuberculosis, or need for immediate hospitalisation. The primary endpoint is days with restrictions from ARTI within 14 days after randomisation. Secondary outcomes are antibiotic use in terms of antibiotic prescription rate and duration of antibiotic treatment in days, days off work and days with side-effects from medication within 14 days, and relapse rate from the infection within 28 days after randomisation. DISCUSSION: We aim to include 600 patients from 50 general practices in the Northwest of Switzerland. Data from the registry of the Swiss Medical Association suggests that our recruited GPs are representative of all eligible GPs with respect to age, proportion of female physicians, specialisation, years of postgraduate training and years in private practice.

Adult↗
PubMedDate not supplied

[Training of medical practitioners of Russian Federation for dealing with dangerous infections in Stavropol Institute for plague control and for working under the conditions of the emergency situation].

There are no doubts at present concerning the necessity of training medical practitioners in Russia for dealing with specially dangerous infections and for work under the conditions of emergency situations. From the day this institute was founded the training of the corresponding personnel was started: first physicians, then biologists and other specialists, including medical assistants and technicians. Additional programs for training specialists were developed, the State License for conducting the course of special post-diploma training was obtained. Research works on improving the methods of the indication and rapid diagnostics of the causative agents of dangerous infections, reflected in training programs for specialists and practically used in the process of the realization of antiepidemic measures in the zones of emergency situations, were carried out. In training the students the experience of the work of the institute on ensuring the epidemiological safety of the population under the conditions of different emergency situations was taken into consideration.

Academies and Institutes↗
PubMed2003

Investigation of infection control practices and knowledge of hepatitis C among body-piercing practitioners.

BACKGROUND: Body piercing has become increasingly popular, leading to concerns about the associated risk of hepatitis C virus (HCV) transmission during piercing. Many body-piercing practitioners (BPPs) have recently entered the industry but little is known about their training and understanding of HCV transmission. This study measured BPP knowledge about HCV and infection control procedures. It also tested for HCV contamination within body-piercing establishments. METHODS: BPPs completed a questionnaire about the number and type of piercings performed, their methods for disposing of and reprocessing piercing equipment, and their training and knowledge of HCV. Environmental swabs were collected and tested for HCV RNA. RESULTS: BPPs at 35 establishments were recruited. A total of 31 BPPs had training as a BPP, ranging from 1 hour to 6 years (median: 15 days). Reprocessing of equipment was variable; 8 establishments inadequately reprocessed piercing guns and 4 inadequately reprocessed forceps or guiding equipment. All BPPs were aware of HCV but many did not know how the virus was transmitted. A total of 19 BPPs performed extra cleaning after piercing a customer known to be HCV positive. No environmental swabs tested were positive for HCV RNA. CONCLUSIONS: This study showed that many BPPs had inadequate training, and lacked knowledge and understanding of HCV transmission, infection control, and universal precautions. To reduce the risk of HCV transmission, BPPs should be required to undergo formal training in infection control before being registered as BPPs.

Chi-Square Distribution↗
PubMed1994

Infection control for general practice.

This paper, which is part of a course on infection control, includes basic guidelines for infection control i the offices of general practitioners.

Disinfection↗
PubMed1995

Factors influencing the wearing of protective gloves in general dental practice.

The present study was undertaken to explore the factors that influence decisions regarding wearing of gloves in the setting of private general practice. A survey of 250 dentists in Brisbane, Australia (41% of the total private general practitioners in the region), was conducted. Routine use of gloves was commonplace (84.6%); however, many dentists experienced skin problems related to glove use. Years of experience and unsolicited patient comments regarding glove wearing were significantly associated with patterns of glove use, while other factors examined did not exert a significant effect (practice profile, practice location, frequency of treating patients known to have an infectious disease, rate of sharps injuries, choice of glove material, and frequency of adverse mucosal and cutaneous reactions). These results revealed the need for further educational campaigns in practical infection-control measures for all practitioners, regardless of their level of experience. An educational approach used by the authors is described.

Attitude of Health Personnel↗
PubMed1989

Infection control in general dental practice. Results of a postal survey of 600 registered dental practitioners in New South Wales.

A postal survey of 600 dental practitioners in New South Wales was conducted in 1986 to establish a data base on current infection control protocols as they apply to everyday dental practice. Three hundred and sixty-three replies (60 per cent) were returned, representing approximately 16 per cent of Australian Dental Association members in New South Wales (1987).

Communicable Disease Control↗
PubMed1994

Information management in infectious diseases: survival of the fittest.

Like all physicians, infectious disease practitioners are concerned and uncertain about their future role as the United States undergoes a major reform of its health care system. Managed care has become the dominant type of health care provided to most patients in the United States, and specialists are increasingly threatened as patient referrals decrease, reimbursements decline, and health care organizations preferentially recruit primary care physicians over specialists. These changes may represent a potential shift in responsibilities and duties for many infectious disease practitioners. The primary role of the infectious disease physician has traditionally been consultative, although many practitioners have organized programs in infection control, hospital epidemiology, and antibiotic management. These programs have become more important as managed care organizations understand the implications of their potential cost savings. The value of these programs will also be significantly enhanced by the ongoing revolution in medical information management that is being driven by computerization. This paper outlines the enlarging role of computerized information management in clinical patient care and its impact on infectious disease practitioners who are increasingly involved in infection control, hospital epidemiology, and antibiotic management programs, as well as in the development of computerized clinical information systems.

Communicable Diseases↗
PubMed1991

Health promotion and disease prevention for the international traveler.

International travel is becoming increasingly popular with Americans, whether for business or pleasure. Approximately 10 to 15 million U.S. citizens travel abroad each year, and more than 8 million of these travel to developing nations. Travelers risk exposure to viral, bacterial and parasitic diseases not often encountered in the United States. Clients planning an international journey should be encouraged to obtain advice from their primary care practitioner. This article reviews the health care needs of the international traveler, including predeparture evaluation, required and recommended immunizations, and advice on disease-prevention measures.

First Aid↗
PubMed2004

Central venous catheters: a survey of ICU practices.

AIM: This paper describes the current infection control practices for CVC care and compares these to evidence-based practice guidelines. BACKGROUND: Intensive care patients with central venous catheters (CVCs) are at risk of catheter-related infection, which increases morbidity, mortality and health care costs. Infection control practices, including care of intravenous administration sets and catheter sites, are undertaken by nurses in an attempt to avoid infection. Although practice guidelines are available, infection control practices may vary between practitioners and institutions; however, current practice has not been formally surveyed. METHOD: A prospective, cross-sectional descriptive survey was carried out. Intensive care units (n = 14) in Australia were surveyed about their infection control policies for CVC care. Results were tabulated and compared with evidence-based practice guidelines. RESULTS: A wide variety of responses was received about duration of administration set use for standard, parenteral nutrition and propofol (lipid-based anaesthetic) infusions; ad hoc administration set connection technique; dressing frequency, materials and solutions; and barrier precautions used during procedures. There was inconsistent adherence to the guidelines. CONCLUSION: There is variation in the infection control approach to CVC care. Greater adherence to existing Centers for Disease Control Guidelines would assist in the standardization of best practice and facilitate evidence-based care.

Australia↗
PubMed1998

Historical analysis of the Ebola virus: prospective implications for primary care nursing today.

Ebola continues to attract worldwide attention as a highly lethal virus of unknown origin that leaves victims bleeding to death and has no known vaccine or cure. The purpose of this historical research was to review and analyze the primary and secondary sources available on Ebola for use by primary care nurses in the event of future outbreaks. A rich resource of history has been well documented by some of the original physicians, virologists, and members of international teams, but nothing was found to be documented by nurses during these outbreaks. Multiple themes emerged including the origins of the viral strains of Ebola, transmission factors, epidemiology, virology, nonhuman and genetic research, treatment, and clinical implications. This research will provide primary care nurses with historical information about Ebola to help in future treatment options and algorithm development.

Africa↗