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PubMed2005

Sexually transmitted infections -- factors associated with quality of care among private general practitioners.

OBJECTIVES: To study the factors associated with quality of sexually transmitted infection (STI) care among private general practitioners in Gauteng. METHODS: We analysed 1 194 records of patients attending 26 randomly selected GP practices in the first 3 months of 2000 and 2002, for 3 STI syndromes, namely urethral discharge, pelvic inflammatory disease and genital ulcers. We assessed adherence to nationally accepted STI treatment guidelines and analysed the influence of patient and practice-level variables on effectiveness of STI drug regimens and trends over time. RESULTS: After controlling for syndrome mix, district and time period, appropriate drug treatment for STIs was significantly associated with the client having medical aid (p < 0.001), recent graduation as a medical practitioner (p < 0.001) and male GP gender (p = 0.007). Between 2000 and 2002, STI care improved for clients with medical aids but for not cash clients. CONCLUSIONS: There was variation in the quality of prescribing for STIs among GPs and positive trends in this prescribing. There is a need for interventions that address the financial incentives that may hamper quality of STI care for cash clients.

Family Practice↗
PubMed2005

Controlling tuberculosis in the United States. Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America.

During 1993-2003, incidence of tuberculosis (TB) in the United States decreased 44% and is now occurring at a historic low level (14,874 cases in 2003). The Advisory Council for the Elimination of Tuberculosis has called for a renewed commitment to eliminating TB in the United States, and the Institute of Medicine has published a detailed plan for achieving that goal. In this statement, the American Thoracic Society (ATS), CDC, and the Infectious Diseases Society of America (IDSA) propose recommendations to improve the control and prevention of TB in the United States and to progress toward its elimination. This statement is one in a series issued periodically by the sponsoring organizations to guide the diagnosis, treatment, control, and prevention of TB. This statement supersedes the previous statement by ATS and CDC, which was also supported by IDSA and the American Academy of Pediatrics (AAP). This statement was drafted, after an evidence-based review of the subject, by a panel of representatives of the three sponsoring organizations. AAP, the National Tuberculosis Controllers Association, and the Canadian Thoracic Society were also represented on the panel. This statement integrates recent scientific advances with current epidemiologic data, other recent guidelines from this series, and other sources into a coherent and practical approach to the control of TB in the United States. Although drafted to apply to TB control activities in the United States, this statement might be of use in other countries in which persons with TB generally have access to medical and public health services and resources necessary to make a precise diagnosis of the disease; achieve curative medical treatment; and otherwise provide substantial science-based protection of the population against TB. This statement is aimed at all persons who advocate, plan, and work at controlling and preventing TB in the United States, including persons who formulate public health policy and make decisions about allocation of resources for disease control and health maintenance and directors and staff members of state, county, and local public health agencies throughout the United States charged with control of TB. The audience also includes the full range of medical practitioners, organizations, and institutions involved in the health care of persons in the United States who are at risk for TB.

AIDS-Related Opportunistic Infections↗
PubMed1998

STD and HIV screening in general practice: a survey related to termination of pregnancy in south Thames.

It has been recommended that screening for sexually transmitted disease (STDs) be carried out at the time of termination of pregnancy to allow prevention of post-abortion infection. Screening offers the opportunity to treat an infected woman and prevent serious complications following the termination procedure. Our findings indicate that general practitioners (GPs) in South Thames did not routinely carry out screening and few realized it took place at referral centres.

Abortion, Induced↗
PubMedDate not supplied

Immune complications associated with chronic transfusion.

Blood transfusion and component therapy are an integral part of treatment for patients with certain life-threatening illnesses. Any benefit derived from transfusion must be weighed against the potential risk for complications. Patients who are chronically transfused present a unique challenge to practitioners. The presentation will focus on alloimmunization to red blood cell antigens, platelet refractoriness, transfusion-associated graft-versus-host disease, and cytomegalovirus infection. Prevention or management of these complications also will be discussed.

Blood Group Incompatibility↗
PubMed1994

Acute liver injury associated with nonsteroidal anti-inflammatory drugs and the role of risk factors.

BACKGROUND: Hospitalizations for acute liver injury in the absence of a viral infection or any other well-defined pathologic finding that could have caused it is rare. In this study, we included both outpatients and hospitalized patients with acute liver injury to estimate the risk of clinically important acute liver injury associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and to study the role of certain risk factors. METHODS: This was a retrospective cohort study with secondary case-control analysis. The study included 536 general practitioners' practices in England and Wales for the period October 1987 through August 1991. A total of 625,307 persons who received more than 2 million prescriptions for one of 12 NSAIDs were followed up to estimate the risk of newly diagnosed acute liver injury. RESULTS: There were 23 cases of acute liver injury. The incidence of acute liver injury was 3.7 per 100,000 NSAID users or 1.1 per 100,000 NSAID prescriptions. None of the cases had a fatal outcome. Sulindac was the only NSAID with a substantially greater risk than that for the overall NSAID group. Users of NSAIDs who had rheumatoid arthritis had a 10-fold increased risk of acute liver injury compared with NSAID-treated patients with osteoarthritis. Concomitant exposure to other hepatotoxic medications also increased the risk. Transient minor increases in liver test values were not a useful predictor of diagnosed NSAID-associated acute liver injury. CONCLUSIONS: Although NSAIDs have been found to be associated with acute liver injury in a small number of persons, the risk is sufficiently small as to be of minimal concern for most NSAIDs.

Acute Disease↗
PubMed1993

Using experiential training to enhance health professionals' awareness of patient compliance issues.

PURPOSE: To educate health care practitioners about medication compliance by having them play the role of patients who have been placed on a medication regimen. METHODS: In 1988, ten physicians and ten nurses working in the Acquired Immune Deficiency Syndrome Clinical Trials Unit of Tulane University and Louisiana State University participated in a compliance protocol designed to enable them to better understand the experience of their patients, who were involved in a three-year controlled trial of azidothymidine (zidovudine) for asymptomatic persons infected with the human immunodeficiency virus. Over the three-year trial, the patients were expected to take three pills five times a day at four-hour intervals every day. To gain experiential understanding of this prolonged, intensive medication regimen, the physicians and nurses agreed to follow their patients' pill-taking schedule by using placebos for seven days, and they kept diaries of their reactions to the seven-day experience. Two years later, a follow-up assessment was done to ascertain the participants' opinions about whether the seven-day experience had had a lasting, positive influence on the way they addressed compliance issues with patients. RESULTS: The primary barriers to medication compliance recorded by the participants were time-related difficulties in following such a strict, unvarying schedule (e.g., frustration at having to repeat the pill-taking five times a day at regular intervals). Other frequently recorded difficulties were social barriers to public pill-taking (e.g., being stigmatized as ill or different). The follow-up results indicated that the participants felt that the seven-day experience was a relatively fast, painless, and helpful means of educating themselves about the problems their patients face. CONCLUSION: By playing the role of patients, the physicians and nurses learned to recognize sources of patient noncompliance with medication regimens, and, as the follow-up indicated, they were able to generalize the role-playing experiences to later interactions with patients.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[A handling program for resistant pneumococci. Physicians sometimes neglect mandatory notification].

Streptococcus pneumoniae infections belong to the leading worldwide causes of illness and death among young children, people with underlying debilitating medical conditions, and the elderly. Following early documentation of infections due to pneumococcal strains with reduced penicillin susceptibility in Australia in 1967, and of infections due to penicillin-resistant strains in South Africa in 1978, pneumococcal resistance to penicillin and other antibiotics has progressed rapidly and is now a global problem. In Sweden, notification of the occurrence of pneumococci with a minimum inhibitory concentration (MIC) > or = 0.5 mg/L for penicillin G (PcG) has been mandatory for general practitioners (GPs) and clinical microbiological laboratories since 1 January 1996. In 1996, 1,057 cases of infection by such pneumococci were reported by microbiological laboratories, but only 262 cases by GPs. With a view to minimising the impact of pneumococci with reduced penicillin susceptibility in Sweden, the National Board of Health and Welfare set up a working group of experts in November 1994. To reduce the transmission of such bacteria in the community, the working group introduced a control programme which includes the isolation of day-care children under six years of age carrying pneumococci with PcG-MICs > or = 0.5 mg/L. An enquiry among the 25 regional centres for infectious disease control in the country to ascertain compliance in the different counties of Sweden showed the programme to have been adhered to in a majority of counties, although many had chosen alternative measures to deal with the problem.

Disease Notification↗
PubMedDate not supplied

In vitro effect of Reiki treatment on bacterial cultures: Role of experimental context and practitioner well-being.

OBJECTIVE: To measure effects of Reiki treatments on growth of heat-shocked bacteria, and to determine the influence of healing context and practitioner well-being. METHODS: Overnight cultures of Escherichia coli K12 in fresh medium were used. Culture samples were paired with controls to minimize any ordering effects. Samples were heat-shocked prior to Reiki treatment, which was performed by Reiki practitioners for up to 15 minutes, with untreated controls. Plate-count assay using an automated colony counter determined the number of viable bacteria. Fourteen Reiki practitioners each completed 3 runs (n = 42 runs) without healing context, and another 2 runs (n = 28 runs) in which they first treated a pain patient for 30 minutes (healing context). Well-being questionnaires were administered to practitioners pre-post all sessions. RESULTS: No overall difference was found between the Reiki and control plates in the nonhealing context. In the healing context, the Reiki treated cultures overall exhibited significantly more bacteria than controls (p < 0.05). Practitioner social (p < 0.013) and emotional well-being (p < 0.021) correlated with Reiki treatment outcome on bacterial cultures in the nonhealing context. Practitioner social (p < 0.031), physical (p < 0.030), and emotional (p < 0.026) well-being correlated with Reiki treatment outcome on the bacterial cultures in the healing context. For practitioners starting with diminished well-being, control counts were likely to be higher than Reiki-treated bacterial counts. For practitioners starting with a higher level of well-being, Reiki counts were likely to be higher than control counts. CONCLUSIONS: Reiki improved growth of heat-shocked bacterial cultures in a healing context. The initial level of well-being of the Reiki practitioners correlates with the outcome of Reiki on bacterial culture growth and is key to the results obtained.

Adult↗
PubMed2006

The situation of tuberculosis and tuberculosis control in animals of economic interest.

The need to focus international attention on the continuing problem of tuberculosis in animals of economic interest, can hardly be over-emphasized. Mycobacterium bovis, is the most universal pathogen among the mycobacteria and produces progressive disease in most domestic animals (especially those of economic interest) and in humans. The prevalence of animal tuberculosis therefore, has relevance for both human and veterinary medical practitioners and decision makers on the strategic approach to be adopted in the control of the disease. There is the tendency to underestimate the ability of M. bovis to produce tuberculosis or to assume that it has been totally eliminated and that potential exposure to this pathogen may be a remote occurrence. This perception could have a direct implication for the control of the disease at source, that is in domestic animals. The current epidemic of human immunodeficiency virus (HIV) infection raises the issue of what future impact this epidemic may have if the incidence of M. bovis infection in humans increases, when control in livestock especially cattle, is neglected by both developed and developing countries.

Animals↗
PubMed2004

Practical treatment of pain in patients with chronic wounds: pathogenesis-guided management.

In addition to its own inherent morbidity, the pain associated with chronic wounds presents a primary obstacle to healing. To initiate safe and effective therapy, we used a multidisciplinary approach that required the wound-healing clinician and pain-management practitioner to work together to diagnose and treat the pain associated with these wounds. This approach emphasizes wound pathophysiology, which facilitates treatment modalities that focus on the cause of the pain as well as more efficient analgesia. All wound patients were approached with the assurance that they should not experience pain. The most important part of pain control is objective assessment and assuring patients that their pain will be resolved. Differential diagnosis is critical (eg, wound pain associated with infection, necrosis, spinal cord injury, neuropathy). We determined that to resolve pain, the following 4 goals must be achieved: (1) removal of all nonviable, locally infected tissue and elimination of all cellulitis; (2) determination of wound pathogenesis; (3) availability of both local and systemic analgesia; and (4) assessment of objective improvement through the periodic use of an analgesic scale. By following this protocol, the wound-healing clinician can expect decreased length of hospital stay and resolution of pain in nearly all patients with wounds.

Aged↗
PubMed2005

21st century endodontics. Part 1.

Root canal treatment techniques probably develop and change more frequently than any other area of dental practice and it can be hard for the busy general dental practitioner to keep up to date. The aim of this series of five papers is to give a thorough review of current teaching and practice. This will encompass the rationale of root canal treatment, guidance on the latest technical procedures for preparation and obturation of the entire root canal system, and consideration of how these principles may contribute to successful treatment. The series will address the following issues: diagnosis and treatment planning; root canal morphology and access; control of infection by effective isolation and anti-microbial agents; the philosophy of modern canal preparation techniques; single- or multi-visit treatment with relevant canal medication; obturation; diagnosis of failure and considerations in re-treatment. It is hoped that readers will be encouraged by the series to question their own techniques, audit their outcomes, and adopt new techniques only after careful reflection of the underlying principles involved.

Humans↗
PubMed2001

Drug treatment of nonviral sexually transmitted diseases: specific issues in adolescents.

Sexually transmitted diseases (STDs) are common and happen more frequently in younger patients. These adolescents have unique risks of acquiring infection because of developing psychosocial skills, biological factors and sociocultural barriers. The clinician must be adept at identifying and modifying these risks through knowledge of the adolescent stages of development and biology, with good history and examination skills that make teens comfortable during their evaluation, and with patient education and treatment. Whereas patient compliance and partner notification can be problematic in any population, teenagers may be more prone not to follow through on these issues. While compliance may notbe as important as previously thought, there is a dearth of studies of patient compliance and STD treatment in adolescents. Guidelines for the treatment of STDs were published by the Centers for Disease Control and Prevention (CDC) in 1998 and the Medical Society for the Study of Venereal Diseases in 1999. Most of the data obtained to formulate these guidelines were not necessarily adolescent specific and few studies, if any, have included adolescent patients since the CDC document was published. In the treatment of chlamydia, it appears that even with relative noncompliance with the 7-day regimen of doxycycline, it is as effective as single dose azithromycin. This has implications in cost control, important for centres with limited funds for treatment. While fluoroquinolone-resistant gonorrhoea has been reported for some time, the number of reports in the US is increasing, with a recent report of decreased susceptibility to azithromycin. As many studies have shown efficacy with single agent therapy with azithromycin in combined gonococcal and chlamydial infection, one must view these new resistance data with concern and give serious consideration to dual agent treatment, especially in the locale of the practitioner. Also, fluoroquinolone use is not advised in patients under the age of 18 years at present because of concerns of adverse effects on cartilage. While not much has changed from the 1998 guidelines for most of the other STDs, there seems to be a general trend in treating pelvic inflammatory disease (PID) on an outpatient basis if good follow-up is assured, even in the adolescent population. There is still debate on whether anaerobe coverage is needed in PID without tubo-ovarian abscess or other complications. One other update includes the use of daily metronidazole gel instead of twice daily usage in the treatment of bacterial vaginosis. With the lack of studies specific to adolescents, it is left up to the clinician to tailor the treatment of adolescents on the basis of current guidelines and patient preferences.

Adolescent↗
PubMed1990

[Imaging of the urinary tract in adults. A guideline for general practice].

This article discusses the indications for imaging of the urinary tract from the general practitioners' point of view. Urography should be used in the control of patients with previous attacks of ureteral colic, in patients presenting macroscopic hematuria and as a preoperative investigation prior to extracorporal shock wave lithotripsy (ESWL). Ultrasound should be chosen in patients with microscopic hematuria and non-specific abdominal pain. Computed tomography should be used in cases with non-specific findings using urography and ultrasound. There are no indications for imaging in women with recurrent urinary tract infection, in men with benign prostatic hypertrophy and in the evaluation of hypertension.

Adult↗
PubMedDate not supplied

Building community partnerships to improve HIV prevention efforts: implications for nurses.

Acquired immune deficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV), is a major and complex public health crisis. The Centers for Disease Control and Prevention (CDC) issued effective community-based HIV prevention planning in its 1993 "Supplemental Guidance on HIV Prevention Community Planning" through the formation of community planning groups (CPGs). These guidelines are reviewed along with behavioral and social science theories that are the crux of HIV prevention theory-based research and program development. Nurses' roles in community-based HIV prevention as community advocates, HIV prevention program planners, practitioners, and researchers are discussed. The article concludes with nursing implications for HIV prevention.

Attitude to Health↗
PubMed1995

Global eradication of donovanosis: an opportunity for limiting the spread of HIV-1 infection.

Genital ulcer disease (GUD) is well recognised in the developing world as a co-factor for heterosexual HIV transmission. Men with GUD are an important high frequency HIV transmitter core group in the general population but few interventions have targeted such individuals so far. Donovanosis is an uncommon GUD with low infectivity characterised by large ulcers that bleed readily and has been identified as a risk factor for HIV in men in Durban, South Africa. Donovanosis is also endemic in Papua New Guinea, India, Brazil and amongst the Aboriginal community in Australia. This curious geographical distribution is unique to any of the sexually transmitted diseases (STD) and might lend itself to control measures not tried previously. In the 1950-60s a global eradication programme was successfully introduced against yaws but this strategy has not been implemented against any of the STD. Donovanosis is a symptomatic disease usually diagnosed on clinical grounds and could be targeted for eradication. Any programme would need to be community-based and require co-operation with both hospital doctors, private general practitioners, nurses, primary health care workers, pharmacists and traditional healers. Donovanosis is usually treated by readily available antibiotics but treatment failure may occur in advanced HIV disease. Drug compliance is often a problem but may be improved by counselling. Early implementation of an eradication programme targeting men with donovanosis could have a significant impact in limiting the spread of HIV in donovanosis-endemic countries and would pre-empt the possibility of both the emergence of drug resistance and treatment failure in individuals with immune impairment.

AIDS-Related Opportunistic Infections↗
PubMed1993

Current status of clinical trials in HIV disease in Australia.

Clinical trials in Australia in diseases related to human immunodeficiency virus (HIV) have steadily expanded from the earliest national study of zidovudine to a range of trials either actively recruiting or being activated that cover a wide spectrum of primary viral, opportunistic infection and opportunistic malignant diseases. From its earliest establishment as the National Health and Medical Research Council special unit to its current role as the clinical trials unit of the National Centre in HIV, this central group has organized a coordinated approach to the conduct of clinical trials that has been a hallmark of Australia's response to the treatment of HIV-related disease. The original local trials were in the form of collaboration in multicenter trials, initiated by the pharmaceutical industry, with the participation of only a few major treatment centers. This has now evolved to a network of more than 20 hospital and ambulatory care centers and a group of enthusiastic and committed general practitioners who have contributed data to a number of major studies. These include the national zidovudine study that generated data on the use of surrogate markers such as CD4 and p24 antigen as predictors of survival, studies of the combination of acyclovir and zidovudine that have indicated a new direction in combination antiretroviral therapy, placebo-controlled studies of zidovudine in asymptomatic individuals that may alter the timing of introduction of therapy, and the MRC/INSERM study of didanosine in advanced disease that will give the clearest indication of its activity yet to be reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Antiviral Agents↗
PubMed2004

Acute respiratory infections in Pakistan: have we made any progress?

Acute respiratory infections (ARI) are the leading cause of death in young children in Pakistan, responsible for 20-30% of all child deaths under age 5 years. This paper summarizes the research and technical development efforts over the last 15 years which have contributed to improving the effectiveness of the case management strategy to reduce mortality from pneumonia in children in Pakistan. Community intervention is viable, effective and practical. Rising antimicrobial resistance among commonly used and low-cost oral agents is of significant concern. Appropriate monitoring and evaluation of the impact of the ARI control programme is lacking. Lack of funding for programmatic activities, lack of coordination with other child survival programs, inadequate training for community health workers and general practitioners in the private sector, lack of public awareness about seeking timely and appropriate care, and insufficient planning and support for ARI programmatic activities at provincial and district levels are major hindrances in decreasing the burden of ARI in the country. The recent introduction of the community-based Lady Health Worker (LHW) Programme and WHO and UNICEF-sponsored integrated management of childhood illness initiative present ideal opportunities for re-emphasizing early case detection and appropriate case management of ARI. Ultimately, focusing on preventive strategies such as improving nutrition, reducing indoor pollution, improving mass vaccination, as well as introduction of new vaccines effective against important respiratory pathogens will likely have the most impact on reducing severe ARI and deaths from severe disease.

Acute Disease↗
PubMed2004

Nonsteroidal anti-inflammatory drugs in veterinary ophthalmology.

Uveitis is a common sequela to many ocular diseases. Primary treatment goals for uveitis should be to halt inflammation, prevent or control complications caused by inflammation, relieve pain, and preserve vision. Systemic and topical NSAIDs are essential components of the pharmaceutic armamentarium currently employed in the management of ocular inflammation by general practitioners and veterinary ophthalmologists worldwide. NSAIDs effectively prevent intraoperative miosis; control postoperative pain and inflammation after intraocular procedures, thus optimizing surgical outcome; control symptoms of allergic conjunctivitis;alleviate pain from various causes of uveitis; and circumvent some of the unwanted side effects that occur with corticosteroid treatment. Systemic NSAID therapy is necessary to treat posterior uveitis, because therapeutic concentrations cannot be attained in the retina and choroid with topical administration alone, and is warranted when diseases, such as diabetes mellitus or systemic infection, preclude the use of systemic corticosteroids. Risk factors have been identified with systemic and topical administration of NSAIDs. In general, ophthalmic NSAIDs may be used safely with other ophthalmic pharmaceutics; however, concurrent use of drugs known to affect the corneal epithelium adversely, such as gentamicin, may lead to increased corneal penetration of the NSAID. The concurrent use of NSAIDs with topical corticosteroids in the face of significant preexisting corneal inflammation has been identified as a risk factor in precipitating corneal erosions and melts in people and should be undertaken with caution[8]. Clinicians should remain vigilant in their screening of ophthalmic and systemic complications secondary to drug therapy and educate owners accordingly. If a sudden increase in patient ocular pain (as manifested by an increase in blepharospasm, photophobia, ocular discharge, or rubbing)is noted, owners should be instructed to contact their veterinarian promptly.

Administration, Oral↗