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PubMedDate not supplied

Genital chlamydial infection: diagnostic practices of general practitioners in Melbourne, Australia.

BACKGROUND AND OBJECTIVES: There is marked underdiagnosis of genital chlamydial infection in Victoria, Australia, and little is known about the diagnostic or treatment practices of general practitioners (GPs) for this condition. Such information is required to develop more effective epidemiologic surveillance and control of this disease in Australia. GOAL OF THIS STUDY: To measure indicators of knowledge and practices of GPs in Melbourne in relation to their diagnosis and management of genital chlamydial infection. STUDY DESIGN: A self-administered questionnaire delivered by mail to a random sample of 327 Melbourne GPs. RESULTS: The response rate was 83%. Female doctors were significantly more likely to test symptomatic patients and to screen asymptomatic patients than were male doctors. Having a large proportion of patients in the high-risk age groups was not a reliable predictor of diagnostic practices. Only 49% of respondents knew how to correctly take specimens for diagnosis of chlamydial infection, and only 41% knew the disease is notifiable. CONCLUSION: Underdiagnosis of chlamydia is due partially to general practitioners having a low level of suspicion of the disease in their patients and to inappropriate specimen collection technique. The present system of chlamydia surveillance is inadequately measuring disease trends, and the information from this survey should be useful in the development of medical training programs.

Adult↗
PubMed2001

A randomised controlled trial of delayed antibiotic prescribing as a strategy for managing uncomplicated respiratory tract infection in primary care.

BACKGROUND: Despite evidence that uncomplicated lower respiratory tract infection (cough) does not respond appreciably to antibiotics and that bacterial resistance is increasing, general practitioners (GPs) still prescribe frequently. AIM: To assess delayed antibiotic prescribing as a strategy for reducing the unnecessary use of antibiotics for cough in primary care. DESIGN OF STUDY: Open randomised controlled trial of delayed versus immediate prescribing of antibiotics. SETTING: One hundred and ninety-one adult patients with uncomplicated cough in 22 Scottish practices who would have received antibiotics under the GP's usual practice were randomised to receive either an immediate prescription (92 patients) or a delayed prescription (99 patients). METHOD: Delayed subjects were asked to wait a week before deciding whether to collect their prescription. Outcome measures included symptom duration, prescription uptake, patient satisfaction, patient enablement, and subsequent consultation rates. The 48 GPs who recruited patients were surveyed six months after the trial to see whether they used delayed prescribing as a part of their normal practice. RESULTS: Study and control groups were similar at baseline. Of the subjects in the delayed arm, 55% did not pick up their prescription. Although most patients were satisfied, more patients in the immediate arm were very satisfied with the treatment (P = 0.001) and the consultation (P = 0.03). The patients in the immediate arm were also more enabled (3.3 versus 2.4; P = 0.04), although more of them intended to consult for similar complaints in the future (85% versus 69%, P = 0.02). We were unable to detect any difference in actual consulting behaviour in the follow-up period (mean = 15 months [SD = 5 months]). Subsequently, 68% of GPs used delayed prescribing at least monthly; all gave the prescription to the patient. CONCLUSION: Delayed prescribing is effective at reducing the use of antibiotics for self-limiting cough; however, patients are less satisfied and enabled as a result. Patients may be deterred from consulting rather than becoming enabled.

Adult↗
PubMed2006

Management of chronic hepatitis B virus infection: current perspectives for the nurse practitioner.

PURPOSE: To address the clinical management of chronic hepatitis B virus (HBV) infection. DATA SOURCES: Studies from the National Library of Medicine that examine the natural history, prevention, and antiviral therapy of chronic HBV infection, with emphasis on recent studies. CONCLUSIONS: Chronic infection with HBV is a frequent cause of cirrhosis, liver cancer, and liver-related mortality worldwide. Strategies to prevent infection, screen for liver cancer in HBV carriers, and treat chronic hepatitis B are all important in managing this disorder. IMPLICATIONS FOR PRACTICE: Much can be done to prevent and treat infection. Both classes of drugs to treat hepatitis B, nucleoside analogues and interferons, have advantages and disadvantages. Selection of therapy should be based on biochemical, histological, and virological parameters as well as consideration of several practical issues.

Acute Disease↗
PubMed2002

Knowledge, attitudes, behaviour and prevalence of TB infection among dentists in the western Cape.

Tuberculosis (TB) remains the most important communicable disease in the world and in South Africa it accounts for 80% of all notifiable diseases. The impact of HIV on the TB epidemic is potentially catastrophic. HIV increases the susceptibility of the HIV-positive person to TB. The resurgence of TB as a public health problem has rekindled interest in this disease among oral health workers. The major concern is the risk of transmission in the dental setting. The aim of this study was to determine the prevalence of TB among dental practitioners and to assess their knowledge, attitudes and practices pertaining to TB. A cross-sectional survey was carried out. A structured questionnaire was used to obtain information on demography, infection control, TB status, behaviour, knowledge and perceived risk. In addition, Mantoux and multipuncture tests were performed to assess prevalence. The response rate was 78%. The sample consisted of 78 dentists, 80% male, with a mean age of 40 years. Ninety-two per cent reported always using gloves, 78% masks (68% surgical masks and 18% paper masks) and 50% glasses when treating patients. Two-thirds reported that they sterilise suction and three-in-one tips. Only 11% reported use of a rubber dam. No practitioner reported the use of high-volume externally vented aspirators or ultraviolet germicidal irradiation. Five per cent reported ever being diagnosed with TB, all after having qualified as a dentist. Half of the sample reported having being vaccinated against TB. The prevalence of those who developed a positive reaction was 33%. Thirty-one per cent reported having referred a patient suspected of having TB for further diagnosis and management. Dentists have a duty to take appropriate precautions to protect themselves, their staff and their patients from the risk of cross-infection. The implementation of infection control policies is critical to the provision of such protection. In addition, a dental health facility provides the opportunity for TB screening which has not as yet been tapped into to its fullest extent in a developing country setting where TB is endemic. Referral and integration of TB screening in high HIV and TB prevalence areas will provide early diagnosis, treatment of TB and possibly prevention and reduced risk of nosocomial infection.

Adult↗
PubMed2005

Risk factors for infections with Norovirus gastrointestinal illness in Switzerland.

Viral infections, particularly those caused by noroviruses (NV, genus Norovirus), are the most common cause of community-acquired gastroenteritis in Europe, with respect to both endemic and epidemic occurrence. For the first time, a general practitioner-based case-control study was performed between July 2001 and July 2003 in the German-speaking part of Switzerland in order to identify risk factors for sporadic NV infections. The consumption of different foodstuffs and of bottled mineral water did not show any significant association with the risk of NV gastroenteritis, nor was there any significant effect of individual ABO histo-blood group or household size on the incidence of NV gastroenteritis. The findings are consistent with person-to-person transmission as the most important route of transmission for community-acquired, sporadic NV infection, in that 39% of all patients reported they had had contact with ill persons before their illness. The fact that 33% reported contact with ill persons, mainly within family groups, after their own illness suggested that a substantial proportion of patients were part of family mini-outbreaks.

Adolescent↗
PubMed1999

Task force studies. Infection rates, surgical site management, & foley catheter infections.

The Florida Hospital Association established a task force to create standard definitions and criteria for infections in home care. In addition, among other goals, the task force wanted to increase awareness among practitioners that home health is part of the health care continuum and all aspects of care, including infection control. The task force studied site-specific infection rates, surgical site management, and foley catheter infections.

Catheterization↗
PubMed2000

Quantifiable risk in dentistry--a letter to the profession.

Recent attention to certain worries such as the AIDS "epidemic," biofilms in dental unit water lines, and hepatitis C have resulted in unbalanced and often inappropriate action by dentists and public health authorities. These actions include exaggerating, underestimating, and ignoring risks in the dental environment. To be effective and responsible practitioners, we must recognize reality and proportion, concentrate resources on the greatest problems, and seek dependable epidemiology. Infection control issues are an important application for this form of evidence-based science.

Humans↗
PubMed2002

[A case of multiple bone and joint tuberculosis which had been misdiagnosed as the rheumatoid arthritis and treated with prednisolone for eleven months].

A 34-year-old man had a multiple arthralgia for about eleven months. The swelling of his right wrist and foot had appeared in the dorsal side, and he had been misdiagnosed as the rheumatoid arthritis. He was treated with prednisolone in the dosages of 2.5 mg per day for one month, and 10 mg per day for ten months. When he admitted to our hospital, the bone X-ray examinations of the wrist and foot revealed the marked atrophy and destruction of the carpal and tarsal bones. The aspiration fluid from the swelling around his wrist and foot was positive for acid-fast bacilli on smear and Mycobacterium tuberculosis was found on culture. He was treated with isoniazid, rifampicin, ethambutol and pyrazinamide, however, these medication was not adequately effective to his complications of tuberculous arthritis. Curettage, irrigation and synovectomy of his right carpal and tarsal bone were performed in order to control his bone and joint infection. He recovered from his arthritis and tenosynovitis after these operations. The clinical practitioners should not omit tuberculosis from the differential diagnosis of persistent osteoarthralgia.

Adult↗
PubMed1991

Prevention of sexually transmitted diseases: a randomised community trial.

STUDY OBJECTIVE: The aim was to evaluate the effectiveness of a programme for the prevention of sexually transmitted diseases which affect fertility. DESIGN OF THE PREVENTION PROGRAMME: The programme took place in six French geographical departments. Three of these, randomly selected, served as experimental departments while the other three were matched with the first three and served as controls. DESIGN OF THE EVALUATION: Genital discharge was used as the indicator of a sexually transmitted disease. In each department, about 40 voluntarily participating general practitioners (263 in total) gathered information on the frequency of infected patients and on their characteristics, both before and after the campaign. PATIENTS: Before and after the programme respectively, 412 and 288 women and 117 and 94 men with a genital discharge were described. MEASUREMENTS AND MAIN RESULTS: After the programme, tests for chlamydia trachomatis were prescribed more often to both women and men with a discharge in the experimental departments. The characteristics of women having consulted a general practitioner with a discharge differed according to the department group studied. In the experimental departments, the women were younger than those in the control departments and had fewer sexual partners. In contrast to the results obtained for women, no behavioural changes were observed among men with a discharge. CONCLUSIONS: The results may indicate a decreased risk in spread of infection. Methodological problems associated with such a design are discussed. There is a need to develop specific messages aimed at changing male sexual behaviour. The study design has implications for the best strategy in delivering prevention messages to the general population which are relevant to the present AIDS epidemic.

Adolescent↗
PubMed1991

Managing infection control, hazards communication, and infectious waste disposal.

Dentistry entered a new era in the 1980s when the development of the AIDS crisis targeted dental facilities as one source of potential cross-infection with pathogenic microorganisms. As governmental agencies "discovered" dentistry, regulations forced practitioners to assume duties not previously required. Also, substantial costs of compliance became a significant consideration to employers. Managing the compliance and cost considerations of governmental regulation requires dedicating personnel, preferably one person, to the management of infection control, hazards communication, and infectious waste disposal tasks. predictably, this person--the safety supervisor--will develop into the new auxiliary specialist of the 1990s.

Communicable Disease Control↗
PubMed1999

Current concerns about control programs in temperate climates.

Efforts to control cyathostome nematodes in temperate climates have not been uniformly successful, as evidenced by contemporary reports of clinical disease and widespread anthelmintic failure. Indeed, effective control is confounded by numerous factors, including ignorance of local transmission patterns, confusing or conflicting control recommendations, and use of ineffective anthelmintics or regimens. Most of these problems are universal rather than being climatically unique, and it is important to recognize that they are mere symptoms of larger and more comprehensive problems. The most basic problem in managing cyathostomes is inadequate knowledge of biological factors that influence control recommendations. These include population dynamics, arrested development, host resistance, and regional bionomics. Another hindrance is the absence of objective criteria to define effective control. Target fecal egg counts are arbitrary and subjective, and parameters to measure the subclinical impact of cyathostome infection in well-managed horses have not been identified. The final general challenge to effective parasite control is motivation and education of equine practitioners and horse owners, who currently receive much of their parasite control information in the form of biased advertising. Ultimately, more effective equine parasite control will result from collaborative efforts of basic research, clinical application, and improved information transfer.

Animals↗
PubMed2005

Average annual risk of tuberculous infection in India.

Estimates of the prevalence of tuberculous infection among children 1-9 years of age were available for four defined zones of India from a recently concluded tuberculin survey. These were pooled together and the average annual risk of infection in the country was computed as 1.5%. It was higher in urban areas, at 2.2%, than in rural areas, at 1.3%. The results call for further intensification of tuberculosis control activities, especially in urban areas, greater involvement of private practitioners and information, education and communication (IEC) for high-risk groups, to reduce the diagnostic and treatment delay thereby reducing the transmission of infection in all settings.

Child↗