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PubMed1992

[HIV infection: survey among practicing physicians in Bern].

With increasing numbers of HIV-infected patients, practitioners will play a crucial role in the prevention of HIV infection and in the care of infected persons. To assess the need for accurate education programs we investigated by questionnaire the current practice, attitudes and knowledge of 1057 practitioners (general, internists, surgeons, dermatologists, gynecologists), on care, prevention and treatment of HIV infection and HIV-related problems in the Canton of Berne (population 1 million), Switzerland. 65% of the practitioners provided completely evaluable responses. More than 90% had already prescribed HIV tests by the end of 1989. A majority rejected routinely performed tests (e.g. for all pregnant women, for all patients before surgery). Only about 50% considered a patient's informed consent mandatory before each test. Primary prevention by sexual history-taking was only rarely done in current practice. All recommendations from the Swiss "Stop Aids" campaign were supported, and even experimental measures such as allowing i.v. drug use in street corner agencies or controlled distribution of heroin were supported by the majority. Mandatory testing of risk groups was favored by about 50% but almost nobody wanted to establish name records of persons with risk behaviour. By the end of 1989 about one third of practitioners regularly cared for HIV-infected persons. Most practitioners would prefer to care independently for asymptomatic HIV-infected persons, but would favor a specialist support when caring for symptomatic patients. Lack of medical skills and knowledge was the main reason for their reluctance in caring for patients. Skilled and experienced practitioners were more prone to care for additional patients and were more active in prevention. Knowledge about HIV transmission, HIV-related complications and treatment was good among general practitioners and internists. However, there was some confusion about the indications for active vaccination in Aids patients. The readiness of Bern practitioners to care for HIV-infected persons is already large and could be increased by improving their medical knowledge. However, it is unlikely that more medical information alone will improve their prevention activities. It appears that education programs aimed at improving the prevention activities of practitioners are best designed and performed by their skilled and experienced colleagues.

AIDS Serodiagnosis↗
PubMed2000

Service provision patterns by main diagnoses and characteristics of patients.

Service provision patterns may be influenced not only by clinical oral health status leading to a diagnosis and treatment plan, but also by other variables such as patient characteristics. The main aim of this study was to investigate whether associations between services provided and patient factors would persist after controlling for the main presenting diagnosis or condition. A random sample of dentists surveyed in 1993-94 provided a response rate of 74%. Private general practitioners recorded service provision data from logs of 1-2 typical days of practice. Caries (26.5%) was the most prevalent diagnosis, followed by recall/maintenance care (19.0%), pulpal/periapical infection (10.9%), and failed restorations (10.4%). Diagnoses were associated with variation in the percentage of patients receiving services in main areas of service, and also with insurance status, sex and age distributions of patients, and type of visit (chi-square; P< 0.05). Logistic regressions of receipt of services indicated statistically significant associations with patient characteristics and diagnosis categories. Controlling for diagnosis, uninsured patients and those visiting for emergencies had less favourable service patterns (e.g., higher odds of extractions, but lower odds of preventive and crown and bridge services) compared to patients who had dental insurance or visited for check-ups or other non-emergency dental problems. The influence of these factors on services provided has implications of public health importance in terms of appropriateness of care and social inequality.

Adolescent↗
PubMed2003

The influence of diabetes mellitus on postoperative infections.

Clinicians and researchers are linking elevated glucose levels with potential infectious outcomes. Physiologic processes to fight foreign agents are potentially impaired during periods of hyperglycemia. Some of these responses, such as immune function and the inflammatory response, are impaired when they are needed most, such as during the recovery from surgical procedures. Investigators have demonstrated the importance of control of serum glucose postoperatively. Outcomes are improved when tighter glycemic control is practiced. The current literature challenges practitioners to become more cognizant of serum glucose in surgical patients and patients who are critically ill, implementing protocols to gain tighter control of serum glucose in any patient may be appropriate. Further investigation of glycemic control in surgical and other populations will reinforce research findings in this area. Studies should be performed on surgical patients who are particularly vulnerable to DM, glycemic alterations, and postoperative infections, such as patients undergoing peripheral vascular surgery. Further investigations are also needed on the role of hyperglycemia and outcomes in nondiabetic individuals, and on the similarities or differences in glycemic control in types 1 and 2 DM. To increase the generalizability of the study findings, definitions used across studies, such as the type of diabetes, should be standardized. When these studies determine optimal glycemic control practices in a variety of patient populations, clinicians will be able to determine the best practice guidelines to optimize patient care and limit adverse infectious outcomes.

Diabetes Mellitus↗
PubMedDate not supplied

AIDS education in dental hygiene programs in the United States and Canada.

The purpose of this study was to determine school policies, acquired immunodeficiency syndrome (AIDS) -related content areas, and curricula hours devoted to AIDS study in accredited schools of dental hygiene. The sample included all 217 accredited programs in the United States and Canada. Eighty-five percent (184) of the sample completed the 10-item questionnaire. Results reveal that 98% of the respondents include information on the oral disease manifestations of AIDS in their curricula. Over 70% of the sample include material on AIDS etiology, incidence, epidemiology, general clinical symptoms, HIV testing, attitudes and fears of practitioners, and dental hygiene care and treatment. Most schools spend four to 10 curricula hours covering general content on AIDS. Over one-half of the respondents require students to use special infection control protocols. When treating known infectious disease patients. Most schools responding have policies which favor student treatment of HIV-positive patients, and the majority of the respondents do not have a written policy concerning admitting students who are HIV-positive. Less than 30% of the schools teach financing of AIDS-related healthcare or AIDS resources. One respondent admitted not including any AIDS information in the curricula. Results suggest that most accredited schools of dental hygiene in the United States and Canada should include additional information on AIDS in their curricula to ensure student competency in providing oral healthcare to HIV-infected individuals.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Need for guidelines in gastroenterology for the general practitioner.

General practitioners base their clinical strategy on evidence-based medicine and experience. When prospective randomized controlled studies have not provided an answer to a specific clinical question, or when common practice in a certain area is not well established, guidelines formulated by specialists with in-depth knowledge of the field are needed. Studies have shown that gastroenterology guidelines have improved the approach to Helicobacter pylori infection and the management of gastroesophageal reflux disease. Failure to use these guidelines by general practitioners can lead to diagnostic inconsistencies and faulty patient care. This is particularly important in Israel, where the heterogeneous patient and physician populations are characterized by differences in the interpretation of symptoms, disease prevalence, and education.

Family Practice↗
PubMed2002

Could laboratory-based notification improve the control of foodborne illness in New Zealand?

AIMS: To estimate the completeness and timeliness of notifications of seven potentially foodborne diseases in Auckland. METHODS: The diseases audited were shigellosis, salmonellosis, campylobacteriosis, yersiniosis, listeriosis, hepatitis A and verocytotoxigenic (VTEC) E. coli infections. Hospital and community laboratory-confirmed cases for the calendar year 2000 were audited against those notified to the Auckland Regional Public Health Service. Cases were matched on disease, name, date of birth, gender and National Health Index number. RESULTS: There were 3182 laboratory-confirmed cases of the seven diseases identified of which 77% had been notified to the Auckland Regional Public Health Service. The proportion of laboratory-confirmed cases notified ranged from a 65% for hepatitis A to 100% for VTEC infection. The median delay between laboratory confirmation and practitioner notification was two days. Notification of all laboratory-confirmed cases would have resulted in an estimated 145 additional investigations in the year 2000. CONCLUSION: A change to laboratory-based notification could improve public health investigation and control of foodborne disease in New Zealand.

Disease Notification↗
PubMed2006

A controlled study of an HIV/AIDS/STI/TB intervention with traditional healers in KwaZulu-Natal, South Africa.

Traditional healers play an important role in southern Africa culture and health care including the HIV epidemic. Here we report among the first controlled studies of an HIV/AIDS, sexually transmitted infections (STI) and tuberculosis (TB) intervention for traditional healers in South Africa. At baseline 233 traditional healers were assessed in four selected communities in the KwaZulu-Natal province and received either an experimental intervention or a no intervention control condition. The intervention group received training in HIV/AIDS, STI, and TB prevention over 3.5 days as well as a supervisory follow-up visit. At 7-9 months follow-up intervention effects were significant for HIV knowledge and HIV and STI management strategies including conducting risk behavior assessments and counseling, condom distribution, community HIV/AIDS and STI education, and record keeping. The study found a high level of preparedness among traditional healers to work with and refer patients to biomedical health practitioners, yet no higher levels of referral to biomedical practitioners were found after the training.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Effect of implementation of a dyspepsia and Helicobacter pylori eradication guideline in primary care.

BACKGROUND: Many international guidelines address appropriateness, prescribing variability and drug-related expenditure in primary dyspepsia management. AIMS: To evaluate the impact on general practitioner (GP) practice and healthcare costs of a participatory intervention to modify primary dyspepsia and Helicobacter pylori (Hp) infection management, by standardised implementation of an international guideline in the local setting, through a prospective, controlled before-and-after study. METHODS: Primary dyspepsia management was monitored in the Local Health District of Padua; 63 of all 354 local GPs (total patient population: 82,284) took part in a primary-care improvement programme. Measured variables were: mean prescribed gastroscopies/1,000 registered patients, mean expenditure/1,000 registered patients for antisecretories (H(2) blockers) and proton pump inhibitors (PPIs), inter-GP prescribing variability and adherence to guidelines, analysed through prospectively filled-out reports on GP consultations for dyspepsia. A 3-month pre-survey period was compared with a 6-month intervention period following implementation of an agreed guideline. RESULTS: Compared to non-participating GPs, intervention yielded a 30 and 26.4% reduction in H(2)-blocker and PPI expenditure, respectively. Application of the guideline led to an upward trend in endoscopy prescriptions, coupled with a 7% increase in appropriate referrals. Intra-group variability marginally decreased; guideline compliance rose slightly. CONCLUSIONS: Participatory intervention can reduce prescribing variability among GPs and inappropriate esophagogastroduodenoscopies, lowering related costs. Results may not have been spectacular, but in view of the number of patients involved, they may have an important impact on Local Health District expenditure.

Cost Control↗
PubMed1981

Written advice: compliance and recall.

Sixty-two women consulting their general practitioner with symptoms of urinary tract infection were assigned at random to either an experimental group, who were given a set of pre-standardized instructions both verbally and in written form, or a control group, who received the same advice in verbal form only.On follow-up, the written advice was found to increase the amount of information remembered by the patients both about the medication and other behavioural advice, but to have no obvious effect on compliance with the course of antibiotics prescribed.Further research is needed, investigating different diseases, to substantiate these findings and help to decide whether patients in general practice should be given written advice.

Adolescent↗
PubMed1988

Control of infection in general practice: a survey and recommendations.

Twenty general practices in four areas in Britain were surveyed to establish their needs for and practices of sterilising and disinfecting equipment. Of the 327 items of equipment and instruments examined in the survey, 190 were satisfactorily decontaminated, 100 were treated in a way judged to result in doubtful decontamination, and in 37 cases treatment was considered unsatisfactory. Decontamination apparatuses (autoclaves, hot air ovens, and hot water disinfectors) were generally in good working order, but the use of chemical disinfectants was often inappropriate. Recommendations were made on appropriate methods of decontamination for various items in common use in general practice. By virtue of the large numbers of patients treated by general practitioners there is a substantial possibility of transmitting infection; having appropriate methods for decontaminating instruments and equipment is therefore imperative.

Communicable Disease Control↗
PubMed1992

Risky business: setting public health policy for HIV-infected health care professionals.

An analysis of the restrictive proposals provoked by the case of Kimberly Bergalis and four other patients apparently infected with HIV during the course of dental treatment reveals that they resulted from an inability to evaluate appropriately the infinitesimal risk of HIV transmission from practitioner to patient. The proposals also resulted from an effort to create risk prevention policy without appreciating the distinction between regulating things or procedures, which have no human rights, and regulating people, who have rights that should not be infringed without serious justification. This analysis demonstrates that the proposed restrictive policies are not justified because they do nothing to prevent the spread of HIV, and they cause unnecessary and substantial harm to health care practitioners.

American Medical Association↗
PubMed1999

[Basic characteristics of the National Tuberculosis Program in Bosnia-Herzegovina].

National TB Programme (NTP) in Bosnia and Herzegovina was approved on 24th May 1994. Following the recommendations of WHO Working Group we revised and supplemented NTP of Bosnia and Herzegovina for 1996 and 1998/99. The objective of the programme was provide practical guidelines on implementation of TB control to all lung diseases and TB specialists over the territory of Bosnia and Herzegovina in accordance with WHO Global Program. TB control through NTP is implemented on the following health care levels: primary health care, General practitioner and family doctor, dispensary of Lung Diseases & TB, Hospitals (Cantonal and Regional), Clinical for Lung Diseases & TB. The effects of this NTP are the following: high sputum smear conversion rates at the end of the initial phase, high cure rates decreased prevalence of chronic excretors of tubercle bacilli, decreased transmission of infection, prevention of drug-resistance. Very good results were achieved in the last three years in TB control with stable incidence through by passive case findings, active finding of contacts, proper and controlled treatment using DOTS strategy as the best TB prevention.

Bosnia and Herzegovina↗
PubMed1989

Current prosthodontic practice: a dental laboratory survey.

A survey was distributed to dental laboratory owners at the 1988 annual meeting of the Minnesota Dental Laboratory Association. Current laboratory practice in infection control, the use of nonprecious alloys, the amount of time devoted to complete removable prosthodontics, and complete denture laboratory techniques were surveyed. Responses indicate a moderate level of awareness and compliance with infection control techniques recommended by the American Dental Association, a declining demand for removable prosthodontic services, a high percentage of use of nonprecious alloys, and a very high rate of porcelain occlusion requested by dental practitioners. Comparisons with other laboratory surveys and the implications of these results for undergraduate education in prosthodontics are discussed.

Communicable Disease Control↗
PubMed1996

Defining the public health impact of drug-resistant Streptococcus pneumoniae: report of a working group.

Streptococcus pneumoniae is a leading cause of morbidity and mortality in the United States, resulting each year in an estimated 3,000 cases of meningitis, 50,000 cases of bacteremia, 500,000 cases of pneumonia, and 7,000,000 cases of otitis media. As with most respiratory pathogens, rapid, sensitive, and specific diagnostic tests are not available; thus, early in the course of illness, diagnosis of S. pneumoniae infection is usually presumptive, and the choice of antimicrobial therapy is nearly always empiric. In the past, isolates of S. pneumoniae were uniformly susceptible to penicillin; however, penicillin-resistant and multidrug-resistant strains have begin to emerge in the United States and are widespread in some communities. The full impact of the problem is unknown because infection with drug-resistant S. pneumoniae (DRSP) is not a reportable condition for most of the United States. To develop a strategy for minimizing the impact of DRSP, in June 1994, CDC convened a working group of public health practitioners, clinical laboratorians, health-care providers, and representatives of key professional societies. This report describes the three goals developed by the working group that address surveillance, epidemiologic investigation, and prevention and control of DRSP, and the objectives for each goal.

Drug Resistance, Microbial↗
PubMed2006

A survey of bovine viral diarrhea virus testing in diagnostic laboratories in the United States from 2004 to 2005.

Bovine viral diarrhea virus (BVDV) has a great economic impact on the United States cattle industry. The Academy of Veterinary Consultants, the American Association of Bovine Practitioners, and the National Cattlemen's Beef Association have called for the goal of BVDV control and eventual eradication in the U.S.A. One of the key factors in such efforts will be the detection of BVDV infections, particularly targeting persistently infected animals. To assess current BVDV detection methods in the U.S.A., 26 veterinary diagnostic laboratories in 23 states were surveyed. Survey questions related to the types of tests currently offered, the number of tests performed, the reasons for test requests, the type of samples used, whether sample pooling was performed, and whether follow-up testing or information regarding bovine viral diarrhea (BVD) management was provided after positive tests. There was no clear consensus on an individual BVDV testing method, the pooling of samples or the retesting of positive animals. Ear-notch antigen capture enzyme-linked immunosorbent assay (ACE) was the test most frequently performed based on the absolute number of tests. However, when the data were adjusted to reflect individual laboratory choices, the number of ACE and immunohistochemistry tests performed on ear notches was nearly equal. Only 55% of diagnostic laboratories provided BVD management information to producers or veterinarians who submitted positive samples. There was no significant difference in the number of positive tests in laboratories that received the majority of their samples for screening purposes versus laboratories that received the majority of their samples because BVDV was suspected based on clinical signs in a herd.

Animals↗
PubMed1995

Dental care for patients with HIV.

Awareness is growing among dental practitioners of the hazards of blood-borne pathogens, especially since the advent of HIV infection and AIDS. This awareness has promoted fundamental changes in the practice of dentistry. There is no reason, as long as infection control procedures are followed carefully, that otherwise well HIV-positive individuals should not be treated routinely in a standard clinical environment.

AIDS-Related Opportunistic Infections↗