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PubMed2005

No evidence of Legionella infection in general practice patients presenting with acute respiratory infections in The Netherlands.

The role of Legionella spp. in the aetiology of acute respiratory infections (ARIs) is largely unknown. In this case-control study, conducted in a general practitioner setting during 2000 and 2001, nose and throat samples from patients presenting with ARIs (n = 230) and controls (n = 200) were analysed for the presence of Legionella spp. by real-time PCR. Legionella DNA was not detected in any of the cases or controls. Thus, Legionella spp. do not seem to play a role in patients presenting with ARIs, nor were they present in patients who visited their general practitioner for complaints other than ARIs.

Acute Disease↗
PubMed2001

[A randomized controlled trial of the use of CRP rapid test as a guide to treatment of respiratory infections in general practice].

INTRODUCTION: The aim was to assess whether the frequency of antibiotic prescriptions to patients with respiratory infections is reduced when general practitioners (GPs) use a CRP rapid test to support their clinical assessment, and to examine whether the use of the test would have any effect on the course of disease. MATERIAL AND METHOD: A randomised controlled trial was carried out by 35 general practices in the County of Funen, Denmark, with 812 patients with respiratory infection. The main outcome measures were frequency of antibiotic prescriptions and morbidity one week after the consultation, as stated by the patients. RESULTS: The frequency of antibiotic prescriptions was 43% (179/414) in the CRP group and 46% (184/398) in the control group (NS, OR = 0.9). At one 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 patient's 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: From on the present study, the use of a single CRP rapid test to support possible antibiotic treatment of respiratory infections in general practice cannot be recommended.

Anti-Bacterial Agents↗
PubMed1990

Chlamydia trachomatis infections in adolescents.

The guidelines of the Centers for Disease Control should be applied with appreciation of their limitations. The serious sequelae of chlamydial infections in young patients warrant vigorous antichlamydial therapy and specific microbiologic diagnosis. Until public health authorities implement control programs, the efforts of individual practitioners will probably be the mainstay of the flight against C. trachomatis.

Adolescent↗
PubMed1991

Infection control and hazards management. Economics of regulatory compliance.

Dentistry has become subject to rapid change in office safety, including infection control and hazards management. This change includes increasingly diverse governmental regulations and compliance with such regulations, influencing the very basics of dental practice. As all practitioners are moving toward compliance, costs are increasing substantially. Various sources estimate such increases at between 12.5% and 19%, and it is doubtful whether third-party reimbursement will offset these additional costs. As practitioners plan methods for offsetting the costs of office safety, consideration should be given to providing patients oral and printed information to preclude misinterpretation of the reasons for fee escalation caused by implementation of chemical hazards communication, infection control, and waste disposal programs mandated by OSHA, EPA, and state or other regulatory authorities. The decade of the 1990s may well become the period of meeting the formidable microbiological and regulatory challenges of the 1980s.

Communicable Disease Control↗
PubMed1995

Postinfectious fatigue: prospective cohort study in primary care.

The idea that chronic fatigue has an infectious origin has become popular, but the main evidence for such an association has come from retrospective case-control studies, which are subject to ascertainment bias. We report a prospective study of the outcome of clinically diagnosed infections in patients presenting to UK general practitioners. Questionnaires assessing fatigue and psychiatric morbidity were sent to all patients aged 18-45 years in the study practices. The prevalence of chronic fatigue and chronic fatigue syndrome was then ascertained among 1199 people aged 18-45 who presented to the general practitioners with symptomatic infections and in 1167 people who attended the surgeries for other reasons. 84% were followed up at 6 months. 9.9% of cases and 11.7% of controls reported chronic fatigue (odds ratio 1.0 [95% CI 0.6-1.1]). There were no differences in the proportions who met various criteria for chronic fatigue syndrome. No effect of infection was noted when we excluded subjects who reported fatigue or psychological morbidity at the baseline screening. The strongest independent predictors of postinfectious fatigue were fatigue assessed before presentation with clinical infection (3.0 [1.9-4.7]) and psychological distress before presentation (1.8 [1.2-2.9]) and at presentation with the acute infection (1.8 [1.1-2.8]). There was no effect of sex or social class. Our study shows no evidence that common infective episodes in primary care are related to the onset of chronic fatigue or chronic fatigue syndrome.

Adolescent↗
PubMed2005

A review of Neospora caninum in dairy and beef cattle--a Canadian perspective.

Neospora caninum is one of the most important causes of abortion in cows. The occurrence of N. caninum infection in beef and dairy cattle has been reported worldwide, and in most provinces in Canada. The objective of this review is to summarize our current understanding of N. caninum in dairy and beef cattle for Canadian bovine practitioners. The review covers the life cycle of the agent, its mechanisms of transmission, clinical signs, and tests for diagnosing the infection. Data on the prevalence of the infection in Canadian dairy and beef cattle are reviewed and briefly compared with estimates from other parts of the world. Most importantly for Canadian bovine practitioners, the impacts of the infection, risk factors for its occurrence, and methods of control are also discussed. By reviewing the scientific literature on N. caninum from a Canadian perspective, culling decisions based on the interpretation of diagnostic tests are more effectively made in the control of N. caninum-associated disease.

Abortion, Veterinary↗
PubMed1997

Managing people with HIV/AIDS--the involvement of Victorian general practitioners.

OBJECTIVE: To examine aspects of knowledge, attitudes, behaviour and practice (KABP) of Victorian general practitioners (GPs) in relation to human immunodeficiency virus (HIV), as part of a larger KABP study relating to GPs and sexually transmissible diseases (STDs). METHOD: Questionnaire survey of 520 randomly selected GPs. RESULTS: A response rate of 85% was obtained. Most respondents were aware of the major risk factors for HIV infection and most GPs obtained consent before HIV testing. More than 22% of respondents had ordered an HIV test that was positive and 39% had been involved with the management of HIV positive patients (asymptomatic, symptomatic or both). The gender of the practitioner (male), greater frequency of STD diagnosis and greater level of ease in treating homosexual men were all significantly associated with having ordered an HIV test that was positive and with ongoing management of asymptomatic and symptomatic HIV positive patients, whereas practitioner age, frequency of advising on safe sex and providing contraceptive advice were not. CONCLUSION: Thirty-nine per cent of Victorian GPs are now managing HIV positive patients, representing a 17% increase since 1989. We found that GP knowledge of HIV transmission and infection control was generally good although information on knowledge and practice beyond initial diagnosis was not sought. Given the evidence of a significant association between practitioner experience in HIV/AIDS management and survival of their patients, there is a need for further research into the educational and support needs of Australian GPs in relation to this increasingly complex area of clinical practice.

Adult↗
PubMed1991

[Microbiology of periodontitis. 1. The infective nature of periodontitis].

In the last years, guided tissue regeneration (GTR) and implantology have opened new possibilities for practical periodontologists in the treatment of advanced cases. For both techniques the successful therapy of the local infection of the pocket is a prerequisite. In the near future rapid tests for microbiological diagnoses and slow release devices for antibiotics will be available to achieve this aim easier. The following article will present the microbiological aspects of periodontitis and plaque control and show their relevance for the practitioner.

Anti-Bacterial Agents↗
PubMedDate not supplied

Nurses' inappropriate use of gloves in caring for patients.

Asepsis still remains an important part of infection control and sterile gloves are still required in acute wound care and surgical procedures. Some tissue viability practitioners have for many years used unsterile gloves for chronic wound care and this provides a cost-effective method of protection for both the patient and the nurse. However, there are still those nurses who are bound in nursing rituals and find it difficult to discard a practice that has been shown to be costly and unnecessary. At the same time, there is a worrying practice of wearing gloves for all procedures without changing between each patient contact and this can be a dangerous method of introducing cross-infection and increasing the potential for latex allergies. Therefore, the use of gloves must be carefully thought through and the rationale for their use should be based on researched evidence. This article reviews the available evidence.

Evidence-Based Medicine↗
PubMed1998

Experience with teicoplanin in non-inpatient therapy in children with central line infections.

Indwelling intravenous catheters are an invaluable part of the curative therapy or terminal care of children with haematological malignancies. The increase in their use has been paralleled by an increase in Gram-positive infections, however. This article provides an overview of non-inpatient treatment of central line infections using teicoplanin. The main drivers for considering non-inpatient therapy were to increase the quality of the patient's life by reducing the amount of time spent in hospital, and to prolong the life of the catheter. A large proportion (95%) of the children in the unit described have indwelling catheters in situ, including Port-a-caths, Hickman catheters and Vascaths. The indications suitable for non-inpatient antibiotic therapy of line infections were those patients near the end of their chemotherapy courses, during terminal care, in non-neutropenic patients to complete an antibiotic course, and in patients with chronically neutropenic aplastic anaemia. Persistent line infections are not always eradicated but usually controlled. Care can take place in the home, in the general practitioner (GP) surgery or in the outpatient clinic. Care can be undertaken by nurses, older patients and parents. Follow-up procedures are in place to ensure safe, effective therapy.

Ambulatory Care↗
PubMed2006

Childhood acute lymphoblastic leukemia and infections in the first year of life: a report from the United Kingdom Childhood Cancer Study.

The United Kingdom Childhood Cancer Study was designed to examine the relation between childhood cancer and preceding exposure to infectious diseases. The authors analyzed the relation between diagnosis (1991-1996) of acute lymphoblastic leukemia (ALL) at ages 2-5 years and clinically diagnosed infections in infancy. Almost all study children (96% of both cases and controls) were taken to a general practitioner for a non-immunization-associated visit at least once before their first birthday. Children diagnosed with ALL had significantly more clinically diagnosed infectious episodes in infancy than did controls; the average number of episodes was 3.6 (95% confidence interval (CI): 3.3, 3.9) versus 3.1 (95% CI: 2.9, 3.2). This case-control difference was most apparent in the neonatal period (< or =1 month); 18% of controls and 24% of ALL cases were diagnosed with at least one infection (odds ratio = 1.4, 95% CI: 1.1, 1.9; p < 0.05). Cases who had more than one neonatal infectious episode tended to be diagnosed with ALL at a comparatively young age; the mean age at ALL diagnosis was 37.7 months for cases with two or more episodes versus 45.3 months for cases with only one episode or none (p < 0.01). These findings support the hypothesis that a dysregulated immune response to infection in the first few months of life promotes transition to overt ALL later in childhood.

Age of Onset↗
PubMed2000

Body piercing: what nurse practitioners need to know.

Body piercing is a growing trend among today's youth. Chances are, nurse practitioners will be in contact with someone who has a body piercing and/or complication relating to piercing. This article includes the history of body piercing, the environment of piercing parlors, the methods commonly used, site-specific explanations of select piercings, complications, treatment and practice implications. Nurse practitioners need to establish collaborative working relationships with their clients as well as those who do the piercings.

Cosmetic Techniques↗
PubMed2006

Waste responsibility: or wasted opportunity?

This article will seek to identify, within the generic role of the theatre practitioner (TP), how effective waste management is crucial to patient care. Its place in infection control will also be discussed, along with issues of health and safety in the workplace. The ramifications of waste disposal are managed by legislation and therefore levels of responsibility, within the healthcare setting, will be explored. Potential difficulties arising from discrepancy between policy and practice will be examined, with a rationale presented for the TP's personal responsibility to keep abreast of changes. Finally, conflicting obligations that impinge on the economics of waste management will be adjudged, along with their implications for patient care now and in the future.

Humans↗
PubMed1992

Intensive surveillance for infections in a three-year study of nursing home patients.

The authors report the results of a 3-year (August 1984-May 1987) prospective study of intensive surveillance for nursing home-associated infections in 666 patients in a 300-bed nursing home in San Diego, California. Ninety-three percent (666 of 714) of the eligible subjects enrolled; 75% were women. The mean age of the subjects was 81.6 years. Lengths of stay ranged from 1 day to 1,025 days, with a mean of 166 days; the cumulative length of stay for all subjects was 110,746 days (303 years). Operational definitions that were heavily dependent on evaluation of clinical signs and symptoms were used by nurse practitioners in weekly or biweekly assessments of all patients to identify infections. The overall incidence of nursing home-associated infection was 7.1 infections/1,000 patient-days. Many of the infections would not have been recognized by persons less skilled than nurse practitioners. Among the 788 nursing home-associated infections identified, 362 (47%) were in the respiratory tract (286 lower respiratory and 76 upper respiratory); 200 (25%) were associated with skin and subcutaneous and mucous membranes; 140 (18%) were symptomatic urinary tract infections; 13 (2%) were bacteremia; and 73 (9%) were other infections.

Adult↗
PubMed1993

Simple approach to acute respiratory infection in rural under five children.

The feasibility of acute respiratory infection (ARI) control in 5,535 rural preschool children was studied. The Primary Health Centre (PHC) staff and local practitioners (drug distribution centres) were identified and trained in recognition of moderate/severe ARI, referral, drug administration and in the education of the community. Functional ARI classification as envisaged in ARI control programme was followed. There was significant reduction in moderate (42% reduction) and severe (89% reduction) ARI episodes from year 1985 to 1987. Both ARI (27.8%) and non-ARI (18.3%) deaths showed reduction. Majority of children who died due to ARI were also unimmunized. The moderate and severe ARI related morbidity and mortality was significantly reduced in immunized children compared to unimmunized children. Although, strategies of National ARI control programme by health education, standard case management and strengthening of immunization is a good thought but it is clear that proper implementation of immunizations is going to pay more dividends. It is also evident that the local medical practitioners should be trained and involved in this control programme to have community faith as well as to avoid opposition.

Acute Disease↗