General practitioners' forum. Flucloxacillin in the treatment of skin and soft-tissue infections.
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Child, Preschool↗
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Antibiotic prophylaxis to prevent post-abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial.
OBJECTIVE: To determine the prevalence of bacterial vaginosis in women undergoing first trimester suction termination of pregnancy and to evaluate the efficacy of metronidazole in reducing the risk of post abortal pelvic infection in women with bacterial vaginosis. DESIGN: Randomised double-blind placebo-controlled trial. SETTING: Two teaching hospitals and one district general hospital. SAMPLE: Two hundred and seventy-three women with bacterial vaginosis undergoing termination of pregnancy. METHODS: Women with bacterial vaginosis, diagnosed using modified Spiegel's criteria, were individually randomised to receive either a 2 g metronidazole suppository or identical placebo per-operatively. Participants, doctors and investigators were blinded to treatment allocation. Participants were asked to complete a questionnaire about post-operative symptoms, visits to the general practitioner, antibiotic treatment, readmission to hospital, contraception and emotional response after one month. RESULTS: The prevalence of bacterial vaginosis was 29.3% (326/1,111). Intention-to-treat analysis showed that post-operative upper genital tract infection developed in 12/142 (8.5%) women allocated to metronidazole and 21/131 (16.0%) women randomised to placebo, a difference of 7.6% (95% confidence intervals -15.4 to +0.2%; relative risk 0.53. 0.27 to 1.03, P = 0.055). The effect of prophylaxis was similar when the analysis was restricted to women receiving the allocated treatment and with complete follow up. There was no difference in the risk of readmission to hospital and the frequencies of self reported symptoms in the two groups were similar. CONCLUSION: This randomised placebo-controlled trial among women with bacterial vaginosis provides weak evidence that metronidazole decreases the risk of upper genital tract infection after first trimester suction termination of pregnancy but a chance finding could not confidently be excluded. Large well-conducted randomised trials with long term outcome measures are now needed to determine the most effective antibiotic combinations and strategy for prevention of post-abortal pelvic infection.
Abortion, Induced↗
American Association of Feline Practitioners 2006 Panel report on diagnosis, treatment, and prevention of Bartonella spp. infections.
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Animal Welfare↗
Prevention of bacterial endocarditis: current practice in The Netherlands. Netherlands Heart Foundation.
A working party of the Netherlands Heart Foundation has formulated guidelines which are simple and uniform in order to encourage maximum compliance. They have been widely publicised among medical and dental practitioners as well as patients. Cardiac conditions requiring or not requiring prophylaxis have been identified. Specific regimens for dental procedures, genito-urinary and gastrointestinal procedures, and drainage of infected tissue have been recommended. A case-control study revealed that compliance with recommendations was low even though patients were aware of the need. While prophylaxis may be worthwhile for the individual, it is concluded that even strict adherence will do little to decrease the incidence of endocarditis in the Netherlands.
Anti-Bacterial Agents↗
Prevalence of Chlamydia trachomatis infection in pregnant patients.
Chlamydia is a sexually transmitted disease of epidemic proportions, infecting an estimated 4 million people a year. It results not only in infertility and ectopic pregnancy but also in infant morbidity and mortality. Ectopic pregnancy is responsible for 11 percent of maternal deaths. About 60 percent of infected women can transmit the bacteria at birth to their infants. Early detection and treatment of chlamydia in both men and women, especially prenatal women, is critical. Chlamydia trachomatis infection of the cervix was found in 8.1 percent of a group of 1,004 pregnant women at a hospital prenatal clinic by means of a direct fluorescent antibody test. The prevalence of C. trachomatis was only 0.7 percent in 277 pregnant women receiving prenatal care from private practitioners. All patients between 27 and 30 weeks gestation who tested positive were treated with oral erythromycin. Their partners were treated with tetracycline. The outcome of pregnancy in patients treated for chlamydial infection was compared with a control group of noninfected mothers from the same population. The frequency of premature rupture of the membranes, prematurity, and low Apgar scores among the treated women were not significantly different from those in the control group. There was a significant difference, however, between the two groups in the incidence of low mean birth weight infants and the presence of meconium. Children can acquire a chlamydial infection at birth from contact with infected cervico-vaginal secretions. If not detected and treated, these infected infants may develop conjunctivitis, bronchiolitis, and pneumonia. It is suggested, therefore, that all patients at prenatal clinics be screened for chlamydial cervicitis. Those testing positive and their partners should be treated.
Adult↗
[Preliminary information to patients and presentation by Burkinabe physicians of the results of HIV detection test in Burkina Faso].
BACKGROUND: The action of individuals and their family is determining in the result of AIDS control and the knowledge of people's serological situation facilitates their involvement in AIDS control. This study was carried out in order METHODS: A transversal investigation through a self-administered anonymous questionnaire was carried out among the 250 Burkinabe physicians working in a public, private or religious health care sector. The questionnaire was sent by mail, attached to a response coupon. A response of 74% was obtained. RESULTS: Seventy seven physicians, that is 48.7% of the sample, informed patients who were likely to be HIV infected about their intention to ask for an HIV test. Seventy five physicians, that is 47.5% of the sample informed patients on the results of their serological tests on HIV infection. The characteristics of physicians who informed customers on the results of their serological test were similar to those of physicians who informed their patients on the demand for test concerning them. There were often specialists, physicians with long experience in medical practice and physicians more involving in curative consultations than in preventive ones (respectively 54.7% versus 23.3%, p=0.002). CONCLUSIONS: These results show the necessity of providing young physicians with counselling training, especially general practitioners who should be working in prevention services. Moreover, they constitute a basis for an objective discussion between physicians working in hospital, officials in charge of the national program for AIDS control and medical training schools.
Burkina Faso↗
Urban, low-income, African-American and Hispanic youths' negative experiences with condoms. Implications for nursing intervention.
Research suggests that the rate of HIV infection is increasing dramatically in African-American and Hispanic youths who live in low-income, urban areas. Nurses need information about these youths' negative experiences with condoms to intervene effectively in the spread of acquired immune deficiency syndrome. This article discusses negative experiences with using condoms that were reported by a subsample of condom users (n = 975) from a household probability sample of low-income, urban, African-American and Hispanic youths. Condom users were asked about 12 different negative experiences with condoms. Results from this household survey highlight a need for nurses to provide clients with specific directions about how to use condoms correctly and to encourage clients to practice putting on condoms.
Adolescent↗
Reimbursement for advanced practitioners examined; new laws address disease transmission, employment discrimination, advance directives.
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Acquired Immunodeficiency Syndrome↗
Creutzfeldt-Jakob disease. The story so far.
CJD continues to be an increasing problem for perioperative practitioners to be aware of. Maureen Dyke reviews the implications for perioperative practice.
Creutzfeldt-Jakob Syndrome↗
Symposium on infections in the compromised host. Hematologic effects of cancer chemotherapy.
Use of the antineoplastic agents frequently causes myelosuppression and neutropenia. Neutropenic patients often fail to manifest the usual signs and symptoms of infection; they are unable to mount an adequate inflammatory response and infection disseminates rapidly. There is a direct correlation between the degree of granulocytopenia and the incidence and severity of infections. During the period of granulocytopenia (the vulnerable period) the risk of infection is high. While safeguarding the patient throughout the entire period of hospitalization, nurses should be more vigilant during this time. They must be alert to subtle signs of infection and the patient should be monitored closely for increased temperature (greater than or equal to 101 degrees F), mouth sores, sore throat, cough, congestion, or dysuria. The patient undergoing chemotherapy faces many threats to survival. This patient also offers an extraordinary challenge to nursing practitioners because good care may significantly improve the patient's quality and length of life.
Antineoplastic Agents↗
A randomized trial of a cognitive coping intervention for acutely ill HIV-positive men.
BACKGROUND: People who are HIV-positive now live longer when they have contracted AIDS, and nursing interventions can help improve their quality of life. OBJECTIVES: To test the effects of an intervention based on developing cognitive coping skills as compared to one focused on facilitating the expression of emotions. Both interventions were intended to help regulate emotional response to an exacerbation of HIV-related symptoms. METHOD: In a randomized, controlled trial, 90 hospitalized HIV-positive men were randomly assigned to one of three groups: cognitive, expression, or control. The intervention was administered on three consecutive days in 20-30 minute sessions. Preintervention and postintervention data were gathered on mood, distress, and anxiety. RESULTS: Both interventions produced a beneficial effect on negative affect (cognitive group p =.002, expression group p =.011), and immediately following the first daily session (p =.001). No change in positive affect was produced by either intervention. Paired t tests indicated a decrease in distress (p =.039), specifically, of intrusive ideation (p =.03), for the cognitive group, which also experienced a decrease in anxiety from immediately before to immediately after each session. Conversely, the expression group experienced an increase in anxiety (p =.018). DISCUSSION: The cognitive coping skills nursing intervention was effective in helping to regulate HIV-positive persons' emotional responses to advanced disease. This nursing intervention is feasible for use by skilled practitioners providing daily care.
Adaptation, Psychological↗
[Drugs in the periodontal pocket. A review of the literature].
The local subgingival administration of antiseptics should, theoretically, help to eliminate the pathological flora of a periodontal pocket and, therefore, help the practitioner in his therapeutical procedures. Several techniques have been utilized and tested, i.e. irrigation with a syringe, with an irrigation device, the method of Keyes and procedures of slow releasing. The results of the numerous investigations with different techniques and drugs have been described and compared. Within the limits of a well designed periodontal treatment the most appropriate and useful techniques are, at present, the following: subgingival irrigations with chlorhexidine (irrigating devices) by the patient himself, subgingival irrigations (syringes) with chlorhexidine or stannous fluoride by the practitioner during curettage, in the near future, slow releasing devices with frequent controls of the bacterial flora (darkfield microscopy) for cases of rapidly progressive periodontitis.
Anti-Infective Agents, Local↗
New developments in the management of STDs.
To assist clinicians in preventing and treating STDs, the CDC recently published new guidelines that not only emphasize treatment, but also prevention strategies and diagnostic recommendations.
Centers for Disease Control and Prevention, U.S.↗
A case-control study of the health status of male farmers registered at Ash Tree House Surgery, Kirkham, Lancashire.
The relative health status of 74 male working farmers registered at Ash Tree House Surgery, Kirkham, Lancashire, was compared with a control group taken from the same surgery. Medical records over a five-year period were analysed to reveal differences in the health status of the two groups. Overall more farmers visited the surgery for acute consultations with the General Practitioner (GP) and significantly (using the chi-squared test for significance) less for health promotion (P < 0.05) than the control group. When visits were classified by disease type, more farmers were found to have visited the surgery with infections (P < 0.05); disorders of the nervous system (P < 0.01); disorders of the skin (P < 0.05) and external causes of injury (P < 0.01). The finding that farmers visit the surgery more often for acute consultations and less for health promotion, coupled with the finding that there are significant differences in the pattern of ill health between the two groups suggest that there is a need for health promotion among the farming community of Kirkham, Lancashire.
Acute Disease↗
A waterborne outbreak of Salmonella Saintpaul.
Contamination of a tank water supply system led to an outbreak of Salmonella Saintpaul with 28 cases of gastroenteritis amongst over 200 workers at a large construction site. The outbreak was identified following notification of two salmonellosis cases by general practitioners from different towns during March 1999. The source of infection, contaminated drinking water, was identified through environmental sampling and confirmed by epidemiological investigations. Frogs and/or mice may have been the original source of the contamination. This report details control measures, the results of investigations and recommendations for future research.
Animals↗
Epidural sufentanil for cancer pain control in outpatients.
Fifteen patients with cancer pain refractory to other methods of pain control were treated with epidural sufentanil. They all suffered from very severe or unbearable pain but had expressed the wish to spend the last period of their lives at home. On the first day of hospitalization, an epidural catheter and a portal catheter were implanted under local anesthesia. Sufentanil was delivered by a portable infusion pump into the portal catheter. The patients remained a further 2-3 days in hospital to titrate the infusion rate to their specific needs and to monitor pain relief and possible side effects. In the home situation, the patients were supervised by their general practitioners. Nine patients had epidural sufentanil as their sole analgesic till they died; six patients needed adjunctive nonepidural medications. There were no epidural- or portal-catheter related infections or cases of respiratory depression. After 1651 patient treatment days, we have found continuous epidural sufentanil infusion to be a safe and effective method for cancer pain control in outpatients.
Adult↗
General practitioners and management of infection with HIV.
General practitioners will have an increasingly important role in the management of patients with the acquired immune deficiency syndrome (AIDS) and infections with human immunodeficiency virus (HIV) as the numbers of cases increase. Altogether 280 general practitioners working in Oxfordshire were sent a postal questionnaire inquiring about their education, knowledge, current practice, and attitudes in relation to managing infections with HIV. Of the 235 (84%) general practitioners who replied, nine out of 10 were giving advice about infection with HIV to their patients. One in two were testing patients for such infection, and one in four were caring for infected patients. Nevertheless, uncertainty remained about the risks of transmission of infection with HIV and general practitioners' knowledge of educational activities for their patients could be improved. The introduction of a facilitator to work with general practitioners in managing patients with AIDS or infection with HIV is planned, especially to help general practitioners develop the skills needed for prevention.
Acquired Immunodeficiency Syndrome↗
Rising trends of STIs and HIV infection in Singapore-- a review of epidemiology over the last 10 years (1994 to 2003).
INTRODUCTION: This is a review of the epidemiology and trends of sexually transmitted infections (STIs) in Singapore from 1994 to 2003. MATERIALS AND METHODS: Data collated for both notifiable and non-notifiable STIs from 1994 to 2003 were analysed. This data consisted of STI notifications from medical practitioners in Singapore as well as from the Department of STI Control clinic itself. RESULTS: There was a decline in the overall STI incidence in Singapore in the first half of the last decade from 215 cases per 100,000 population (7,200 cases) in 1994 to 162 cases per 100,000 population (6,318 cases) in 1999, followed by an increasing trend in the number of acute STIs (both bacterial and viral) over the past 5 years to 195 cases per 100,000 population (8,175 cases) in 2003 (P <0.001). The incidence of HIV has risen sharply over the last decade whilst that of other viral STIs has not decreased. Singaporeans are becoming sexually active at a younger age, with casual partners constituting the main primary contacts. CONCLUSIONS: Although there has been a significant decline in the overall incidence of STIs in Singapore over the last decade, a rise in acute STIs over the last 5 years has resulted in the need to identify the causal factors, and to intensify existing as well as develop new STI/HIV prevention programmes for the general population and certain core groups.
Adolescent↗