Hand-to-hand combat: preventing MRSA.
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Control of human parasitic diseases: Context and overview.
The control of parasitic diseases of humans has been undertaken since the aetiology and natural history of the infections was recognized and the deleterious effects on human health and well-being appreciated by policy makers, medical practitioners and public health specialists. However, while some parasitic infections such as malaria have proved difficult to control, as defined by a sustained reduction in incidence, others, particularly helminth infections can be effectively controlled. The different approaches to control from diagnosis, to treatment and cure of the clinically sick patient, to control the transmission within the community by preventative chemotherapy and vector control are outlined. The concepts of eradication, elimination and control are defined and examples of success summarized. Overviews of the health policy and financing environment in which programmes to control or eliminate parasitic diseases are positioned and the development of public-private partnerships as vehicles for product development or access to drugs for parasite disease control are discussed. Failure to sustain control of parasites may be due to development of drug resistance or the failure to implement proven strategies as a result of decreased resources within the health system, decentralization of health management through health-sector reform and the lack of financial and human resources in settings where per capita government expenditure on health may be less than $US 5 per year. However, success has been achieved in several large-scale programmes through sustained national government investment and/or committed donor support. It is also widely accepted that the level of investment in drug development for the parasitic diseases of poor populations is an unattractive option for pharmaceutical companies. The development of partnerships to specifically address this need provides some hope that the intractable problems of the treatment regimens for the trypanosomiases and leishmaniases can be solved in the not too distant future. However, it will be difficult to implement and sustain such interventions in fragile health services often in settings where resources are limited but also in unstable, conflict-affected or post-conflict countries. Emphasis is placed on the importance of co-endemicity and polyparasitism and the opportunity to control parasites susceptible to cost-effective and proven chemotherapeutic interventions for a package of diseases which can be implemented at low cost and which would benefit the poorest and most marginalized groups. The ecology of parasitic diseases is discussed in the context of changing ecology, environment, sociopolitical developments and climate change. These drivers of global change will affect the epidemiology of parasites over the coming decades, while in many of the most endemic and impoverished countries parasitic infections will be accorded lower priority as resourced stressed health systems cope with the burden of the higher-profile killing diseases viz., HIV/AIDS, TB and malaria. There is a need for more holistic thinking about the interactions between parasites and other infections. It is clear that as the prevalence and awareness of HIV has increased, there is a growing recognition of a host of complex interactions that determine disease outcome in individual patients. The competition for resources in the health as well as other social sectors will be a continuing challenge; effective parasite control will be dependent on how such resources are accessed and deployed to effectively address well-defined problems some of which are readily amenable to successful interventions with proven methods. In the health sector, the problems of the HIV/AIDS and TB pandemics and the problem of the emerging burden of chronic non-communicable diseases will be significant competitors for these limited resources as parasitic infections aside from malaria tend to be chronic disabling problems of the poorest who have limited access to scarce health services and are representative of the poorest quintile. Prioritization and advocacy for parasite control in the national and international political environments is the challenge.
Animals↗
Relationships among and demographic predictors of dentists' self-reported adherence to national guidelines.
How dentists learn about and integrate new procedures and techniques into dental practice are major concerns in innovation research in dentistry. The purposes of this study were to: (1) develop reliable measures of self-reported adherence to different national guidelines; (2) to examine the relationships among the different measures; and (3) to determine if predictors of these adherence behaviours exist. One thousand U.S. general dentists were asked to complete a survey of adherence behaviours to established guidelines in infection control, radiation protection, and antibiotic prophylaxis. Thirty-five percent responded to the mailed survey. Reliable scales were developed in infection control and antibiotic prophylaxis behaviors. Step-wise multiple regression analysis produced several weak predictors of adherence to guidelines in these two areas. Characteristics of early adopters such as office complexity, membership in professional associations, and year of graduation, were consistent with other dental innovation literature. Significant correlations were found between adherence behaviors in infection control and antibiotic prophylaxis. These correlations do support the findings that practitioners who are early adopters of innovation are likely to do so in more than one area.
Anti-Bacterial Agents↗
The effect of glove contamination on the bond strength of resin to enamel.
Over the past twenty years infection control protocol has evolved and use of gloves is now mandatory. Practitioners have become aware of potential interactions between the latex gloves and many of the dental material used as well as the potential for contamination from the gloves. The purpose of this study was to evaluate the shear bond strength of bonded restorations to enamel of uncontaminated and contaminated resin adhesive with powder free and powdered latex gloves. The results of the study demonstrated that the resin bonding agent that was in contact with either powdered or non- powdered latex gloves did not have a significant effect on the shear bond strength of the bonded restoration.
Acid Etching, Dental↗
Scientific evidence versus therapeutic demand: the introduction of the sulfonamides revisited.
Because of recent changes in Federal Food and Drug Administration (FDA) regulations, new medications may now be marketed before completion of rigorous controlled testing. In order to understand the ramifications of this development, it is instructive to recall the introduction of the sulfonamides in the 1930s. The sulfonamides, the first effective antibacterial agents, were marketed in an era of relatively few regulations. Although investigators at times designed controlled trials to evaluate use of the drugs, both researchers and practitioners generally prescribed them for severe infections, despite a lack of conclusive data as to their efficacy. The clinical usefulness of sulfonamides for a given condition often became known through uncontrolled case studies and comparisons with historical control groups. Given the relaxation of FDA regulations, this method of drug evaluation may again become more commonplace.
Animals↗
Randomised controlled trial of CRP rapid test as a guide to treatment of respiratory infections in general practice.
OBJECTIVE: To assess whether the frequency of antibiotic prescriptions to patients with respiratory infections is reduced when general practitioners (GPs) use a C-reactive protein (CRP) rapid test in support of their clinical assessment, and to study whether using the test will have any effect on the course of disease DESIGN: Randomised controlled trial. SETTING: 35 general practices, County of Funen, Denmark. PATIENTS: 812 patients with respiratory infection. MAIN OUTCOME MEASURES: Frequency of antibiotic prescriptions and morbidity 1 week after the consultation, as stated by the patients. RESULTS: In the CRP group the frequency of antibiotic prescriptions was 43% (179/414) compared with 46% (184/398) in the control group (odds ratio (OR) = 0.9, NS). After 1 week, increased or unchanged morbidity was stated more frequently in the CRP group (12%) than in the control group (8%) (OR = 1.6, p = 0.05). In the control group, the variable having the greatest influence on whether the GP prescribed antibiotics was the patients' general well-being (OR = 2.9, p < 0.0001), whereas in the CRP group the CRP value had the greatest influence (OR = 1.1 per unit increase (mg/l), p < 0.0001). CONCLUSION: Based on the present study, the use of the CRP rapid test in support of a possible antibiotic treatment for respiratory infections in general practice cannot be recommended.
Adolescent↗
[How to prescribe fewer antibiotics in children?].
During the last years, there has been an alarming worldwide increase in antibiotic resistance among bacterial pathogens of the respiratory tract, and particularly pneumococcus. This is generally attributed to extensive use of antibiotics prescribed for respiratory tract infection and the selection pressure they exert on bacterial strains of nasopharyngeal flora. In our opinion, five actions have to be coordinated in order to control this phenomenon. To improve the continuing education of practitioners and the diagnosis between viral and bacterial respiratory infections, to restrict the use for the situations where antibiotics are really necessary, to prescribe in these situations at the right dosage and duration the more potent antibiotics, to plan straight-a-way an alternative treatment in case of failures, finally achieve a prompt implementation of the pneumococcal conjugate vaccine.
Anti-Bacterial Agents↗
A nurse led education and direct access service for the management of urinary tract infections in children: prospective controlled trial.
OBJECTIVES: To determine whether a nurse led education and direct access service improves the care of children with urinary tract infections. DESIGN: Prospective cluster randomised trial. SETTING: General practitioners in the catchment area of a UK paediatric nephrology department. PARTICIPANTS: 88 general practices (346 general practitioners, 107 000 children). MAIN OUTCOME MEASURES: Rate and quality of diagnosis of urinary tract infection, use of prophylactic antibiotics, convenience for families, and the number of infants with vesicoureteric reflux in whom renal scarring may have been prevented. RESULTS: The study practices diagnosed twice as many urinary tract infections as the control practices (6.42 v 3.45/1000 children/year; ratio 1.86, 95% confidence interval 1.42 to 2.44); nearly four times more in infants (age < 1 year) and six times more in children without specific symptoms. Diagnoses were made more robustly by study practices than by control practices; 99% v 89% of referred patients had their urine cultured and 79% v 60% had bacteriologically proved urinary tract infections (P < 0.001 for both). Overall, 294 of 312 (94%) children aged under 4 years were prescribed antibiotic prophylaxis by study doctors compared with 61 of 147 (41%) by control doctors (P < 0.001). Study families visited hospital half as much as the control families. Twice as many renal scars were identified in patients attending the study practices. Twelve study infants but no control infants had reflux without scarring. CONCLUSION: A nurse led intervention improved the management of urinary tract infections in children, was valued by doctors and parents, and may have prevented some renal scarring.
Anti-Bacterial Agents↗
Chronic obstructive pulmonary disease: current comprehensive care for emphysema and bronchitis.
Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of mortality in the United States. Most clients are initially seen when symptomatic and significant lung damage has already occurred; most cases are preventable. There is no cure for COPD, but lifestyle changes (especially smoking cessation) and proper treatment can significantly impact quality of life. The diagnostic tools most commonly used include chest x-ray, arterial blood gases, and pulmonary function tests. Pharmacologic interventions include steroids, bronchodilators, mucolytics, and an armamentarium of antibiotics, which must be selected with careful discretion. Because the prognosis of COPD may be guarded, the practitioner is obligated to provide information on advance directives. A sensitive approach, holistic perspective, consistent follow-up, and clinical astuteness are essential ingredients in the management of clients with COPD.
Anti-Bacterial Agents↗
Glove use by orthodontists in England and Wales: changes since 1989 and comparisons with general dental practitioners.
Glove wearing during patient treatment has been considered to be an integral part of dental surgery cross-infection control routines. The degree of compliance with this recommendation was tested by distribution of a questionnaire to 1950 dentists known to be practising under the National Health Service (NHS) regulations in England and Wales. Of the dentists who replied, 40 were specialist orthodontists. Results indicated that 60 per cent of these orthodontic respondents used gloves routinely for all patients and procedures, while 25 per cent wore gloves for either selected patients or selected procedures. Fifteen per cent never wore gloves. Comparison with results from a similar survey carried out in 1989 indicated increasing compliance by the orthodontic respondents to glove-wearing recommendations. However, the levels of glove use by orthodontists was found to be lower than that of their general dental practitioner colleagues.
England↗
Effects of an educational intervention on the rate of recurrent urinary tract infections in selected female outpatients.
This study was designed to prospectively study the effect of health education on the recurrence rate of urinary tract infections in female outpatients. Thirty-four volunteers were randomly assigned to either an experimental education group or a control group. Controls were offered routine patient information provided by practitioners at the outpatient clinic. Members of the experimental group participated in an educational session which addressed urinary tract infections, its risk factors, and behavioral changes which might reduce its recurrence. At follow-up three months after the educational session, the experimental group had a statistically significant (p less than .05) reduction in the recurrence of urinary tract infections.
Female↗
Treating wounds in small animals with maggot debridement therapy: a survey of practitioners.
Many small animals succumb to complications of serious wounds. Sometimes infection and sepsis overwhelm the animal; sometimes the costs of intensive care overwhelm the owner. Maggot therapy, a method of wound debridement using live fly larvae, could provide effective, simple, low cost wound care. All eight US veterinarians who had been provided with medicinal maggots were surveyed to determine if this treatment was being used for small animals, and for what indications. At least two dogs, four cats and one rabbit were treated with maggot therapy between 1997 and 2003. The most common indications for using maggot therapy were to effect debridement and control infection, especially if the wound failed to respond to conventional medical and/or surgical therapy. Practitioners reported the treatments as safe and often beneficial. Amputation and euthanasia may have been avoided. It is concluded that maggot therapy may have utility for small animals, and should be evaluated further.
Animals↗
Cytomegalovirus infection. Evaluation and management in neonates.
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Aftercare↗
Tuberculosis in long-term care settings. Are you prepared?
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Aged↗
When disaster strikes.
In response to the healthcare issues resulting from Hurricane Katrina, The Nurse Practitioner has compiled information from the Centers for Disease Control and Prevention (CDC) to educate nurse practitioners (NPs) about previously uncommon illnesses presenting in the wake of the disaster, CDC recommendations on immunizations and infection prevention, and guidelines for providing proper wound care. Visit http://www.cdc.gov for full text of these articles.
Communicable Disease Control↗
Infection control as a topic for ward-based nursing education.
The link between nursing theory and practice remains a topic of ongoing debate. Related to this issue is the best place to effectively combine the two. The solution may be ward-based teaching programmes as part of formal continuing staff development, involving collaboration between college-based lecturers and acknowledged clinical experts. Using infection control as an example of a topic in need of regular and continual updating for qualified practitioners, it is argued that such programmes would be desirable because they would afford sufficient flexibility to fulfil individual learning needs and could be assessed to indicate whether nursing practice had been enhanced. Participants could be accredited for successful completion of ward-based programmes.
Accreditation↗
Cross infection control measures and the treatment of patients at risk of Creutzfeldt Jakob disease in UK general dental practice.
AIMS: To determine the suitability of key infection control measures currently employed in UK dental practice for delivery of dental care to patients at risk of prion diseases. MATERIALS AND METHODS SUBJECTS: Five hundred dental surgeons currently registered with the General Dental Council of the UK. DATA COLLECTION: Structured postal questionnaire. ANALYSIS: Frequencies, cross-tabulations and chi-squared analysis. RESULTS: The valid response rate to the questionnaire was 69%. 33% of practices had no policy on general disinfection and sterilisation procedures. Only 10 of the 327 responding practices (3%) possessed a vacuum autoclave. 49% of dentists reported using the BDA medical history form but less than 25% asked the specific questions recommended by the BDA to identify patients at risk of iatrogenic or familial CJD. However, 63% of practitioners would refer such patients, if identified, to a secondary care facility. Of the 107 practitioners who were prepared to provide dental treatment, 75 (70%) would do so using routine infection control procedures. CONCLUSIONS: Most of the dental practices surveyed were not actively seeking to identify patients at risk of prion diseases. In many cases, recommended procedures for providing safe dental care for such patients were not in place.
Adult↗
Guidelines for management of HIV infection with computer-based patient's record.
Computers are steadily being incorporated in clinical practice. We conducted a nonrandomised, controlled, prospective trial of electronic messages designed to enhance adherence to clinical practice guidelines. We studied 126 physicians and nurse practitioners who used electronic medical records when caring for 349 patients with HIV infection in a primary care practice. We analysed the response times of clinicians to the situations that triggered alerts and reminders, the number of ambulatory visits, and hospitalisation. The median response times to 303 alerts in the intervention group and 388 alerts in the control group were 11 and 52 days (p < 0.0001), respectively. The median response time to 432 reminders in the intervention group was 114 days and that for 360 reminders in the control group was over 500 days (p < 0.0001). There was no effect on visits to the primary care practice. There was, however, a significant increase in the rate of visits outside the primary care practice (p = 0.02), which is explained by the increased frequency of visits to ophthalmologists. There were no differences in admission rates (p = 0.47), in admissions for pneumocystosis (p = 0.09), in visits to the emergency ward (p = 0.24), or in survival (p = 0.19). We conclude that the electronic medical record was effective in helping clinicians adhere to practice guidelines.
Acquired Immunodeficiency Syndrome↗