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PubMed1996

An evaluation of one and two airflow filters in preventing the movement of bacteria through the anesthesia circle system.

A review of the literature demonstrated that controversy exists as to whether anesthesia circle systems can be a source of transmission of bacteria to patients. The purpose of this study was to evaluate the use of one airflow filter (on the expiratory limb) versus two airflow filters (one on the inspiratory limb and one on the expiratory limb) in the prevention of bacterial migration in the anesthesia circle system, during general anesthesia, using semiquantitative analysis of the number of bacterial colony forming units (CFUs). This study consisted of two randomized groups receiving one or two airflow filters. Thirty-five volunteers participated in the study. At the conclusion of the surgical cases, a culture was taken of the anesthesia circle system. The cultures were read at 24 and 48 hours for the presence of CFUs. No CFUs were reported in either group. The results of the study were inconclusive. Therefore, the use of one airflow filter on the expiratory limb should remain the standard of care, pending additional research. Some practitioners may use a second airflow filter when there is a greater risk of infection, such as in the case of an immunocompromised patient. However, this study can neither support nor question the effectiveness of this practice.

Air Microbiology↗
PubMed2002

Changes in antibiotic prescribing for children after a community-wide campaign.

CONTEXT: Overuse of antibiotics has contributed to microbial resistance, compromising the treatment of bacterial infections. Very high levels (>50%) of antibiotic resistance among invasive Streptococcus pneumoniae have been documented in Knox County, Tennessee. OBJECTIVE: To determine the effectiveness of a community-wide intervention aimed at reducing inappropriate antibiotic use among children. DESIGN, SETTING, AND PARTICIPANTS: The Knox County Health Department led a multifaceted year-long campaign (May 1997 through April 1998) aimed at decreasing unnecessary antibiotic use among children. Tennessee's 3 other major urban counties (Shelby, Hamilton, and Davidson) did not conduct similar campaigns and served as controls. Evaluation included white and black children (aged <15 years) enrolled in Tennessee's Medicaid Managed Care Program in the 4 study counties, representing 36% of the study counties' children (464 200 person-years observed). INTERVENTION: Educational efforts were directed toward health care practitioners (primarily via peer leader presentations) and to the parents of young children and the public (primarily via printed materials). MAIN OUTCOME MEASURE: The intervention-attributable effect on antibiotic use, defined as the excess percentage change in oral antibiotic prescription rates in Knox County between the 12-month preintervention and postintervention periods, relative to that of control counties. RESULTS: Antibiotic prescription rates declined 19% and 8% among Knox County and control county children, respectively, yielding an 11% intervention-attributable decline (95% confidence interval, 8%-14%; P<.001). The intervention-attributable decrease in prescription rates was greatest among children aged 1 to less than 5 years (among white children, 8% [P<.001]; among black children, 18% [P<.001]). CONCLUSIONS: A community-wide educational intervention reduced antibiotic prescription levels among children in Knox County.

Adolescent↗
PubMed1987

Economic examination of cefoperazone therapy.

Medical records of 1137 patients from 35 hospitals were reviewed to examine the total cost of care for patients receiving cefoperazone as initial therapy compared to a control group receiving alternative agents. The direct costs of care measurable through a retrospective review of patient records were examined, including the cost of antibiotic acquisition, drug administration, laboratory testing, and room and board. Results of a regression analysis show that cefoperazone as initial therapy is associated with lower costs for all factors studied except acquisition cost. Antibiotic acquisition averaged $24 per patient more for the cefoperazone group (p less than 0.01). However, for cefoperazone patients drug administration was $63 less (p less than 0.0001), laboratory testing costs averaged $9 less (p = 0.22), and costs associated with room and board charges were $80 less (p = 0.40). Total costs averaged $3073 per cefoperazone patient and $3228 per control patient (p = 0.20). These data suggest that the previously accepted definitions of antimicrobial costs (i.e., cost per gram, cost per dose, cost per day) may no longer be adequate in this era of cost containment. In order to make sound clinical decisions with lowest total costs, practitioners should identify how and where costs are incurred.

Anti-Bacterial Agents↗
PubMed2003

The role of cranberry juice in the treatment of urinary tract infections.

There has long been an interest in the use of cranberry, usually as a juice, to prevent and treat urinary tract infections (UTI). This mini-review examined the evidence available using a simple search on an internet-based resource designed to make evidence readily available to practitioners in the South Eastern NHS regions of the UK. The resource, known as KA24, provides access to a range of databases and full text of journal articles. The first stage of the review identified two existing Cochrane Reviews, one examining cranberry as a treatment, the other as prevention. Both concluded that there was insufficient evidence to recommend the use of cranberry in treating UTIs, although some weak research did offer support for cranberry juice in preventing UTIs. A search for further evidence not included in the Cochrane review identified several new reviews and two randomized controlled trials (RCTs) of cranberry as prevention. The reviews were not systematic and came to contradictory conclusions. They were based on a selective reading of the evidence base and gave no criteria for determining the inclusion or validity of studies. One of the RCTs was available for full scrutiny and was appraised as a valid study. Both RCTs found that cranberry (as juice or capsule) significantly reduced the rate of UTI in sexually active women. There is evidence to support the use of cranberry to prevent UTI in some populations but none to support its use as a treatment.

Beverages↗
PubMed1999

Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults.

CONTEXT: The emergence and spread of antibiotic-resistant Streptococcus pneumoniae in US communities is due, in part, to the excessive use of antibiotics for acute respiratory tract infections. OBJECTIVE: To decrease total antibiotic use for uncomplicated acute bronchitis in adults. DESIGN: Prospective, nonrandomized controlled trial, including baseline (November 1996-February 1997) and study (November 1997-February 1998) periods. SETTING: Four selected primary care practices belonging to a group-model health maintenance organization in the Denver, Colo, metropolitan area. PARTICIPANTS: Consecutive adults diagnosed as having uncomplicated acute bronchitis. A total of 2462 adults were included at baseline and 2027 adults were included in the study. Clinicians included 56 physicians, 28 physician assistants or nurse practitioners, and 9 registered nurses. INTERVENTION: The full intervention site received household and office-based patient educational materials, as well as a clinician intervention consisting of education, practice-profiling, and academic detailing. A limited intervention site received only office-based educational materials, and control sites provided usual care. MAIN OUTCOME MEASURE: Antibiotic prescriptions for uncomplicated acute bronchitis during baseline and study periods. RESULTS: Antibiotic prescription rates for uncomplicated acute bronchitis were similar at all 4 sites during the baseline period. During the study period, there was a substantial decline in antibiotic prescription rates at the full intervention site (from 74% to 48% [P = .003]), but not at the control and limited intervention sites (78% to 76% [P = .81] and 82% to 77% [P = .68], respectively). Compared with control sites, changes in nonantibiotic prescriptions (inhaled bronchodilators, cough suppressants, and analgesics) were not significantly different for intervention sites. Return office visits (within 30 days of the incident visit) for bronchitis or pneumonia did not change significantly for any of the sites. CONCLUSIONS: Antibiotic treatment of adults diagnosed as having uncomplicated acute bronchitis can be safely reduced using a combination of patient and clinician interventions.

Acute Disease↗
PubMed1999

Combining feedback from simulated cases and prescribing. Design and implementation of an educational intervention in primary care in Sweden.

OBJECTIVES: To develop and evaluate a new model of continuing medical education (CME) for general practitioners (GPs). The study is part of the joint European Drug Education Project (DEP). This paper presents the Swedish part regarding the design of the evaluation study, the educational methodology, and the participants' evaluation. METHODS: An educational model was developed. Two peer group discussions (facilitated by a GP/pharmacist team), including individual feedback on the GPs' judgments of written simulated cases and prescribing, were main components. The model was tested in a parallel randomized controlled study including 36 GP groups, allocated to education on asthma or urinary tract infections. Background and outcome data were knowledge and attitudes (K/A) assessed by a questionnaire and prescribing practices for actual and written simulated cases. The GPs' evaluation of the model was captured through a questionnaire. RESULTS: All 36 groups completed the program. The mean participation rate in the group discussions was 75%. The response rates were 82-98% regarding outcome data K/A questionnaire and written cases), and 80% regarding the evaluation questionnaire. Prescribing data were captured for 99% of the GPs. Both group discussions were considered important by 84-89%. Eighty-seven percent wished to take part in similar CME activities for other conditions. About 80% reported that their purpose in participating had been fulfilled. CONCLUSIONS: It was feasible to evaluate the developed educational model by using a two-armed parallel study design. The model was well received by the participants.

Adolescent↗
PubMed2000

Contact lens considerations for patients infected with HIV.

BACKGROUND: As an eye care practitioner, one must be aware of the many sequelae of HIV disease and its impact on contact lens patients. With the progressing development of anti-HIV medications, patients infected with HIV are living longer and more productive lives. Thus a greater number of patients infected with HIV may be candidates for contact lens wear. PURPOSE: The eye care practitioner will play an important role in caring for patients infected with HIV who wear contact lenses. Theoretically, contact lens wear in patients infected with HIV could potentially increase their risk of corneal infection particularly from opportunistic pathogens in immuno-compromised patents. METHODS: This article reviews the common anterior segment HIV-related complications that can impact on the ability to wear contact lenses. These complications include: keratoconjunctivitis sicca, herpes simplex, herpes zoster, microsporidial keratoconjunctivitis, molluscum contagiosum, bacterial keratitis, conjunctival microvasculopathy, and Kaposi's sarcoma. "In-office infection control" concerns will be reviewed, along with proper care and disinfection of contact lenses for patients infected with HIV.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Inquiry of veterinarians in Niedersachsen concerning the occurrence of parasitic diseases and their control in large animals].

In Lower Saxony approximately 3500 veterinarians were asked to fill in a questionnaire focused on the prevalence of parasitic infections in cattle, sheep, pigs, and horses, the preferred control measures and the antiparasitic drugs in use. Although the disappointing low number of only 48 veterinarians that participated in this survey prevented any representative conclusions the following trends were remarkable: gastrointestinal strongyles were the most prevalent parasites in cattle (34.8%), sheep (28.0%), and horses (42.3%). In pigs, ascarids were most often diagnosed (41.9%) followed by the strongyles (27.9%). Horse strongyles were stated as parasites causing problems by 40.0% of the veterinarians. Prophylactic measures are performed by most practitioners alone or in addition to therapy in the case of lungworms or gastrointestinal strongyles. Therapeutic application of anthelmintics is broadly in use against cestodes in horses (65.0%) and liver flukes (cattle: 41.7%, sheep: 33.3%, horse: 57.1%). Benzimidazoles represent the dominating group of anthelmintics in sheep (78.3%), horses (42.1%), and pigs (42.0%). In cattle, ivermectin (27.7%) and benzimidazoles (26.5%) are regularly used. The role of pyrantel is largely restricted to the control of helminths in horses (24.2%) whereas levamisole is stated as a frequently applied drug in cattle (20.5%), pigs (12.0%), and sheep (2.7%). The diagnosis of parasites relies generally on coproscopical examination (93.7%) which is mostly performed by the practitioners themselves (51.1%). In general, the traditional diagnostic tools are regarded as adequate. Approximately 50% of the practitioners declare their interest in a support of veterinary herd management by parasitological institutes.

Animals↗
PubMed2004

Incidence and risk factors associated with pressure ulcers among patients with HIV infection.

OBJECTIVE: To assess the incidence of and risk factors for pressure ulcers among patients with advanced human immunodeficiency virus type 1 (HIV-1) infection. DESIGN: Multicenter trial that included 1258 consecutive patients infected with HIV-1 who had 1815 admissions to 16 acute care infectious disease units in Italy. METHODS: Data were collected for demographic, clinical, immunologic, and virologic parameters. The chi-square test was used to compare categorical variables, and the Student t test was used for continuous variables. Univariate analysis was performed to examine possible risk factors for pressure ulcers by computing odds ratios; a multiple logistic regression model was used to obtain adjusted estimates of odds ratios while accounting for all possible risk factors. RESULTS: The incidence of pressure ulcers was 2.31 per 100 admissions, 3.33 per 100 patients, and 1.06 per 1000 patient days. All stages of pressure ulcers were represented in the sample: 7 Stage I (15.9%), 24 Stage II (54.5%), 8 Stage III (18.2%), and 5 Stage IV (11.4%). Multivariate analyses showed that being female, length of hospitalization, and clinical markers of HIV infection were independently associated with pressure ulcers. Mortality rates were 50% among patients with pressure ulcers and 7.2% among patients without pressure ulcers (P <.0001), with an attributable mortality rate of 42.8% and an odds ratio of 12.96 (95% confidence interval 6.99-24.22). CONCLUSIONS: A higher incidence of pressure ulcers was found in patients infected with HIV-1 when compared with noninfected patients. Because a longer hospitalization may increase the risk of developing a pressure ulcer, practitioners should be aware of the clinical conditions that may prolong a patient's hospital stay. Aggressive preventive strategies should be implemented to decrease the complications associated with pressure ulcers among patients infected with HIV-1.

Adult↗
PubMed1990

AIDS/HIV: implications for speech-language pathologists and audiologists.

Great strides have been made in the past year in uncovering the pathogenesis of AIDS/HIV, in administering certain drugs to retard the course of AIDS/HIV, in allaying the concerns of the general public, and in dispelling the many myths regarding AIDS/HIV. ASHA's Committee on Quality Assurance has provided this update as a result of obtaining the most current information from CDC and related AIDS/HIV literature. Human service providers are not at high risk of getting AIDS/HIV as a result of their work with clients, even if they regularly care for persons with AIDS/HIV (American College Health Association Task Force on AIDS, 1987). The risk is associated with coming in contact with blood and body fluids containing visible blood and from needle stick injuries. Guidelines for prevention of transmission of the AIDS virus to caregivers are similar to those of transmission of Hepatitis B. All practitioners should be aware of these guidelines and diligently observe them. This update has relaxed a more stringent approach to guidelines for practitioners when coming into contact with all body fluids since the most recent CDC recommendations caution practitioners to adhere to Universal Precautions if it is anticipated that they might be exposed to blood or body fluids containing visible blood. Also, disposal of materials need not be extraordinary, because only needles, lab waste, and infectious material require the use of hazardous waste red bag container. When practitioners have a question regarding cleaning and maintenance of equipment, it is suggested that they consult manufacturer's instructions. Materials that may come in contact with blood or body fluids should ideally be disposable.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The multidrug-resistant tuberculosis challenge to public health efforts to control tuberculosis.

After years of steady decline, there has been an unprecedented resurgence of tuberculosis (TB) in the United States and outbreaks of multidrug-resistant tuberculosis (MDR-TB). The authors assess the nature, epidemiology, and implications of MDR-TB; provide suggestions for preventing drug resistance among patients with drug-susceptible TB; and offer recommendations for managing patients with MDR-TB. They outline the National Action Plan to Combat MDR-TB. Close collaboration among medical practitioners and staff members of TB control programs is needed to ensure the most effective management of patients with TB and their contacts. This collaboration is one of the most important steps for successful control of MDR-TB.

Communicable Disease Control↗
PubMed1996

Quantitative epidemiology.

We provide guidance for new practitioners in the vocabulary of modern epidemiology and the application of quantitative methods. Most hospital epidemiology involves surveillance (observational) data that were not part of a planned experiment, so the rubric and logic of controlled experimental studies cannot be applied. Forms of incidence and prevalence often are confused. The names "cohort study" and "case-control study" are unfortunate, as cohort studies rarely involve cohorts and case-control studies allow no active control by the investigator. Either type of study can be prospective or retrospective. Results of studies with discrete outcomes (infected or not, lived or died) often are represented best by a form of the risk ratio with 95% confidence intervals. The potential distorting effects of selection bias, misclassification, and confounding need to be considered.

Cross Infection↗
PubMed1983

The need for control of throat streptococcal cultures in general practice.

During recent years, it has become more and more common among general practitioners and pediatricians to inoculate and read agar plates for diagnosis of beta-hemolytic streptococci so that an accurate etiological diagnosis in cases of suspected tonsillitis can be made. As a control of the diagnostic quality, "unknown" streptococcal strains were distributed from the bacteriological laboratory to the practitioners performing this type of diagnostic procedure. The results show that the ability to correctly classify these strains varied greatly. Technical problems such as inadequate temperature control of relatively simple incubators were also found. Continuous education and information on beta-hemolytic streptococcal diagnostic procedures are important to ensure sufficient quality.

Agar↗
PubMedDate not supplied

Implementing nurse prescribing within the haemodialysis unit.

Patients within satellite haemodialysis units do not always have access to a medical practitioner. This may cause problems when prescriptions are required. Amendments to UK law to allow the introduction of supplementary prescribing came into force in 2003 allowing nurses with the appropriate experience, training and qualification to prescribe for their patients. Within a 14-station satellite unit a prescribing partnership has been successfully established. Clinical Management Plans have been implemented for haemodialysis patients. These include areas such as dialysis adequacy, access management, anti-coagulation, anaemia management, MRSA treatment and prophylaxis, antihypertensive therapy, calcium and phosphate control and exit site or line infection. 100% of patients within the unit have consented to the nurse prescribing for them under the Clinical Management Plan. Supplementary prescribing enhances nursing practice by empowering those who are best placed to make decisions regarding care and treatment for their patients. Patients appear confident in the ability of the nurse within the haemodialysis unit to prescribe competently. Nurse prescribing is of benefit to patient care, meeting the demands of an expanding patient population. It is recognition of the skill and experience required of haemodialysis nurses.

Ambulatory Care Facilities↗
PubMed2005

Harmonisation of the acute respiratory infection reporting system in the Czech Republic with the European community networks.

Respiratory virus activity is detected in Europe each winter, yet the precise timing and size of this activity is highly unpredictable. The impact of influenza infection and/or acute respiratory infection in European countries is continuously monitored through a variety of surveillance systems. All of these sources of information are used to assess the nature and extent of activity of influenza and other respiratory viruses, and to offer guidance on the prevention and control of morbidity and mortality due to influenza at a local, national and international level. The early warning system for a forthcoming influenza epidemic is mainly based on the use of a set of thresholds. In the Czech Republic, the acute respiratory infection (ARI) reporting system, with automated data processing, uses a statistical model for the early detection of unusual increased rates of the monitored indicators. The collected data consists of the number of ARI, the number of complications due to ARI and the population registered with the reporting general practitioners and paediatricians, all collected separately in five age groups. To improve the reporting system in the Czech Republic, clinical data on the weekly incidence of influenza-like illness (ILI) within the same population and the same age groups was started in January 2004. These data fit the European Commission's recently adopted ILI case definition and allows a better comparison of data with other countries in Europe, in particular those participating in EISS (European Influenza Surveillance Scheme).

Adolescent↗
PubMed1992

Effect of having siblings in the exam room on parents' retention of clinicians' instructions.

This study investigates the effect of siblings in the examining room on a parent's ability to learn and retain instructions for the care of a sick child. A sample of 49 parents was randomly divided into experimental (E) and control (C) groups. The E parents brought only their sick child into the examining room, while their well children were kept in a supervised waiting room. The C parents brought their well children along with their sick child into the examining room. In all cases, the sick child had either an upper-respiratory infection or an ear infection requiring antibiotics. Instructions to parents dealt with antibiotic treatment and care of the sick child. Each subject took one pretest and two post-tests. Post-test one, given at the conclusion of instruction, measured learning. Post-test two, given two weeks later, measured retention. Results showed that there were no significant learning differences between the groups, but that the E-group parents retained significantly more of the practioner's instructions than the C-group parents.

Adult↗
PubMed1994

Effects of two formats of informed consent on knowledge amongst persons with advanced HIV disease in a clinical trial of didanosine.

To determine subjects' perception of the purpose of informed consent, 113 subjects were recruited from a dose-controlled clinical trial of didanosine (ddI). Subjects were surveyed regarding how they made decisions regarding their medical care in general, about how they obtained information about this trial in particular, and several aspects of the informed consent procedure. Subjects were then randomly allocated to receive information about the trial by either a written only format or a written and verbal format 1 week before commencement of the trial. An eight-item instrument assessed knowledge of ddI prior to and subsequent to receiving information. Most subjects obtained information about HIV-related issues from their specialist (70%) or general (51%) medical practitioner. A large proportion of subjects (88%) reported that they believed their specialist medical practitioner always acted in their best interest. The majority of subjects (79%) believed that subjects should be allowed the choice between participating in the clinical trial and receiving the drug outside the trial mechanism. Of the subjects, 96% believed that informed consent was necessary in clinical trials; however, their opinions of the purpose of informed consent varied widely. Although they signed the informed consent, 44% of the subjects stated that they did not understand 'all' of the information that was provided. We found that the provision of information by written mode alone, or written and verbal modes were both associated with significant increases in knowledge levels and that there was a significant interaction in the degree of change between the two methods, with the written plus verbal method showing the most improvement over time. There was an interaction between degree of improvement in knowledge of didanosine in subjects who received written information versus those who received written and verbal knowledge and time (pre- versus post-consent) and a significant main effect for time. All subjects were relatively well-informed about the drug and stated that specialist and general medical practitioners were their major source of knowledge for all aspects of their HIV health care.

Adult↗
PubMed1996

Diagnosis of urogenital Chlamydia trachomatis infection in women based on mailed samples obtained at home: multipractice comparative study.

OBJECTIVE: To compare urine and vaginal flush samples collected by women at home with endocervical and urethral swabs obtained by general practitioners for their efficacy in the diagnosis of urogenital Chlamydia trachomatis infection. DESIGN: Multipractice comparative study. SETTING: 33 general practices and a central department of clinical microbiology in Aarhus County, Denmark. SUBJECTS: 222 women aged 18-25 years who for any reason had a gynaecological examination. INTERVENTIONS: Endocervical and urethral swabs were obtained by the women's general practitioners. The same women when at home then collected a first void urine sample, a midstream urine sample, and a vaginal flush sample (using a vaginal pipette) and mailed them to the laboratory. MAIN OUTCOME MEASURES: C trachomatis defected by the polymerase chain reaction and the ligase chain reaction. Eight tests for C trachomatis were performed for every woman. When two of the eight yielded positive results the patient was considered infected. RESULTS: The overall prevalence of C trachomatis infection was 11.2% (23/205 women). Test sensitivities in samples obtained by general practitioners, samples obtained at home subjected to polymerase chain reaction, and samples obtained at home subjected to ligase chain reaction were 91%, 96%, and 100% respectively. The corresponding specificities were 100%, 92.9%, and 99.5%. CONCLUSIONS: The diagnostic efficacy of samples obtained by women at home and mailed to the laboratory was as good as for samples obtained by a general practitioner when using the ligase chain reaction. This may have important implications for the practicability of screening for this common, often asymptomatic, and treatable infection.

Adolescent↗