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PubMed2000

HIV risk evaluation.

BACKGROUND: Australia enjoys good control of human immunodeficiency virus (HIV) by world standards and HIV testing is becoming an increasingly integral part of general practice. Nevertheless, HIV testing remains charged both emotionally and medicolegally. OBJECTIVE: To outline the importance of: determining why a patient is requesting an HIV test; helping establish his or her risk of infection; and tailoring counselling interventions. CONCLUSION: Isolated high risk exposure to HIV may be grounds for postexposure prophylaxis. Other issues frequently arise out of HIV risk assessment that represent a greater hazard to the patient than HIV. The general practitioner is ideally placed to prioritise and deal with sexual health and infection issues on an individual basis.

AIDS Serodiagnosis↗
PubMed1984

Problems of medication with the pediatric patient.

During the course of dental treatment, when it is necessary to prescribe pharmacologic agents for the pediatric patient, a drug should be selected that is not only effective but also available in a readily acceptable form. Dosages should be considered carefully. Rather than attempting to adjust adult recommendations, established guidelines for children should be utilized. Manufacturer's doses should be followed when available. If a child frustrates efforts toward treatment and does not respond to nonpharmacotherapeutic management approaches, premedication should be considered. The practitioner should have a thorough medical history before deciding to employ outpatient sedation. This history can be helpful in selecting the most appropriate regimen. Very young children and severely compromised patients are not good candidates for sedation and are best treated under general anesthesia. Narcotic analgesics are rarely indicated for control of pain following dental treatment in children. Nonnarcotic preparations are very effective and will suffice for most procedures. Because prolonged bleeding has been demonstrated, aspirin should be used with caution in surgical cases. Oral administration is recommended for most dental infections requiring antibiotics. In instances when severe infection is encountered, the parenteral route is suggested. A narrow-spectrum, bactericidal agent is preferred; barring allergy, penicillin is the usual drug of choice. When antibiotic prophylaxis is indicated, adherence to American Heart Association guidelines is strongly encouraged.

Alphaprodine↗
PubMed2003

Paediatric community-acquired pneumonia: current concept in pharmacological control.

Community-acquired pneumonia (CAP) is one of the most frequent infections in childhood but it is not easy to establish a rational therapeutic approach for a number of reasons, including difficulties in identifying the aetiology, the fact that the most frequent bacterial pathogens become resistant to commonly used antibiotics and the lack of certain information concerning the possible preventive role of conjugate vaccines. This leads paediatricians to treat almost all cases of CAP with antibiotics, often using a combination of different antimicrobial classes. In order to avoid unnecessary antibiotic use and limit the spread of antibiotic resistance, consensus guidelines for the management of CAP in childhood should be developed and used by practitioners in their offices and hospitals.

Adolescent↗
PubMed2003

Antimicrobial prophylaxis in the surgical patient.

The primary prophylactic measure against postoperative infection is antiseptic technique in patient preparation, during surgery, and in postoperative patient care. Antimicrobial prophylaxis against postoperative infection is not indicated for procedures with a low infection rate because the expected benefit of antimicrobial treatment is less than the risk of an adverse medication reaction. Antimicrobial prophylaxis has been demonstrated to be of greater benefit than risk in some procedures with higher infection rates; however, because the problem is complex and the data are limited, extra-polating these findings to the practitioner's setting and the individual patient remains a challenge (Table 1). Although antimicrobial prophylaxis for bacterial endocarditis is not effective for most patients, the seriousness of the potential infection has driven the creation of guidelines recommending prophylaxis for at-risk patients undergoing at-risk procedures. Applying these guidelines appropriately could help to reduce unwarranted use of antimicrobials. In the prophylactic use of antimicrobials, as in many medical interventions, the difficulty is balancing the risks of the intervention with the potential benefits. Although we do not have either the randomized, controlled trials or the detailed, patient-specific information to estimate this balance precisely, there are general guidelines to help the clinician choose treatment for most patients.

Anti-Bacterial Agents↗
PubMed1988

Evaluation of the Nottingham birth scoring system.

A case-control study of postneonatal deaths occurring in 1974-1976 in the City of Nottingham, England, revealed that most were attributable to respiratory infections and SIDS, and primarily occurred in wintertime, at home, in the less well-off parts of Nottingham. By means of a step-wise discriminant analysis, 9% of the infant population was identified as a high-risk group in whom 53% of postneonatal deaths could be expected to occur. From January 1, 1978, this group of infants was followed up more intensively by health visitors and general practitioners, who gave advice on the early recognition of respiratory symptoms. Although the postneonatal mortality rate fell from 6.5 per 1,000 live births in 1977 to 5.2 per 1,000 in 1983, it is not possible to show that the rate of improvement was any faster after the introduction of the system. The system was discontinued on March 31, 1985. Birth scoring systems are not recommended; instead, resources should be concentrated on general improvements in services and symptom recognition, and basic research into the causes of SIDS.

Child Health Services↗
PubMed1989

Analgesic and antiinflammatory properties of vitamins.

A number of various mechanisms are prone to develop pain symptomatology. Among them infection, inflammation, degeneration, metabolic deviations, and traumas may be at the origin of complex reactions currently gathered under the terminology "rheumatism." For some time now, practitioners have introduced vitamins in the array of their antalgic supply; these were mainly vitamins of the B-group. Meanwhile research has enlarged knowledge about the oxidative mechanisms that are at the origin of inflammation, and has suggested the use of antioxidant substances, among them 9 vitamins. Finally, most of the antalgic drugs used for relief of pains have prooxidative effects, which in turn should be controlled by antioxidant substances. These different interrelations are discussed within the limits of the field of vitamins.

Analgesics↗
PubMed2002

A survey of STI policies and programmes in Europe: preliminary results.

OBJECTIVES: A survey was conducted to assess the adequacy of sexually transmitted infections (STI) prevention and control policies and programmes in the European region (including the central Asian republics). METHODS: An adapted World Health Organization (WHO) model questionnaire was sent to ministry of health officials in all 45 countries of Europe and central Asia. The questionnaire included questions on STI programme structure; STI case management; the different types and levels of services, including public and private service providers; partner notification and screening policies; services for vulnerable populations; monitoring and supervision; surveillance and research. RESULTS: Western European countries largely leave STI prevention and care to individual practitioners. Licensed providers exist at all levels of care, and access to consultations and treatment is usually free of charge. In the newly independent states (NIS), by contrast, programme efforts emphasise state guidance and supervision of local providers rather than individual practitioners. Access to services is limited in that in several NIS, only public sector specialists are licensed to treat STI. Formerly free of charge policies have been severely eroded. While in western Europe access to condoms appears to be good, in the NIS there are many fewer condom outlets. Regionwide, in 40% of countries the distribution of condoms is part of STI consultations. CONCLUSIONS: Non-availability of affordable high quality STI services, including STI treatment and condoms, may be one of the causes for the much higher STI prevalence in parts of eastern Europe and NIS than in western Europe.

Communicable Disease Control↗
PubMed2003

Bacterial corneal diseases in dogs and cats.

Corneal diseases are very common in small animals. Corneal disease associated with bacterial agents is frequent in the dog and maybe less frequent in the cat. The medical history, important steps of the ophthalmic examination, and the ophthalmic diagnostic tests that are relevant in such corneal conditions are outlined. Bacterial corneal diseases in dogs and cats are most commonly considered in one of two categories--bacterial ulcerative keratitis and corneal abscesses. The clinical aspects of these two entities as well as the therapeutic strategies available for general practitioners and ophthalmologists are discussed. Ulcerative keratitis is frequent; it represents the most common ocular diseases in dogs and cats. Because some of these corneal ulcers can be very severe, progress rapidly, and therefore are sight threatening, the crucial steps of their diagnosis and management are stressed. The use of a magnification system, fluorescein dye, and corneal cytology and culture, if indicated, is necessary for diagnosis at an early stage of the disease. The treatment of bacterial ulcerative keratitis should eradicate the infection, reduce or stop the corneal destruction and support the corneal structures, control the uveal reaction and the pain associated with it, and minimize the scarring. The prognosis depends on the stage and the severity of the corneal ulceration, the etiology of the condition, and the therapeutic choice. A close follow-up of animals with corneal ulceration is highly recommended because corneal ulcers can progress rapidly.

Animals↗
PubMed1997

[Infectious risk in medical offices: a reality to be fought].

The notion of nosocomial infection is intimately related with that of working or sejourning in a health care institution and would thus not concern the physician's office. Nevertheless, the risk of infection does exist in this setting, both for patients and personnel, and requires adequate preventive measures. The practitioner is called upon to care for patients who have community-acquired or possibly nosocomial infections following hospitalization and must therefore know the type of germ involved, its characteristics, particularly antibiotic sensitivity, the predominant modes of transmission and preventive measures against propagation, latrogenic infections such as abscess formation at a point of injection or septic arthritis after infiltration may also occur. Other more technical procedures (endoscopy, minor surgery) may also be a cause of contamination. The practitioner also produces wastes (needles, vaccine syringes, dressings) which must be disposed of in accordance with legal regulations. One must avoid contaminating oneself in order not to contaminate others. This requires adequate knowledge and application of elementary rules concerning hand washing, asepsis, antisepsis, and waste disposal, essential links in the chain of infection transmission.

Antisepsis↗
PubMed2000

Nurse practitioner student prescriptive patterns.

As employment of nurse practitioners (NPs) increases in health care systems, there is a need to have current data on their prescribing practices and patterns, and to implement a system for updating such data. This study reports prescriptive data based upon 10,421 primary care visits conducted by 55 family NP students over a 15-month period in 1997 and 1998. Numbers of over-the-counter drugs taken regularly, prescription drugs currently prescribed and prescription drugs prescribed or refilled at the visit were recorded in addition to types of drugs, compliance issues, diagnoses rendered and sociodemographic information. Individual student data were aggregated and analyzed using Epi Info (Epidemiology Program Office of the Centers for Disease Control) and SPSS-PC. Results identified that: 1) the majority of patient visits involved the prescription of 1-2 drugs (88%); 2) major compliance issues included financial concerns, knowledge deficits, and complexity/demands of treatment; 3) commonly rendered diagnoses at drug visits for chronic conditions were hypertension and diabetes; for acute conditions, otitis sinusitis and upper respiratory infections; 4) anti-microbial agents, drugs used for relief of pain, and cardiovascular drugs account for 60% of drug mentions; and 5) the numbers of drugs prescribed or refilled at visits were similar by type of preceptor, except fewer single drugs were prescribed or refilled at visits supervised by nurse preceptors. Findings are discussed relative to deepening the understanding of advanced practice nursing education and the prescribing practices of NP students and their preceptors.

Adolescent↗
PubMedDate not supplied

HIV/AIDS: Traditional systems of health care in the management of a global epidemic.

Cultural preference and the high cost and unavailability of anti-HIV drugs for people living with HIV/AIDS in the developing world leads many to turn to traditional (indigenous) medicine to manage HIV-related illness. Traditional health practitioners can play an important role in delivering an AIDS prevention message and some may be able to offer treatment for opportunistic infections. In industrialized countries, approximately half or more of those with AIDS use complementary medicines in conjunction with their antiretroviral therapy. A growing body of research highlights the immunomodulatory and antiviral potential of plant-based medicines. There are also concerns about unsafe practices and a growth in claims of traditional cures for AIDS. Partnerships between the modern and traditional/complementary health sectors in research, policy, and practice are essential in building comprehensive HIV/AIDS control strategies.

AIDS-Related Opportunistic Infections↗
PubMed2003

Optimal treatment of pyoderma gangrenosum.

The optimal treatment of pyoderma gangrenosum includes a combination of local wound care and systemic medications. Oral and pulse intravenous corticosteroids have traditionally been the most commonly recommended first-line systemic therapies. Cyclosporine, with or without corticosteroids, has more recently emerged as a first-line systemic treatment. A multitude of immunosuppressive and immune-modulating medications, as well as antimicrobial agents with anti-inflammatory properties have also been widely prescribed. Often, it is difficult to achieve control of aggressive cases of pyoderma gangrenosum, necessitating administration of a combination of systemic therapies. Furthermore, patients recalcitrant to one or many medications are frequently reported. Concomitant disease, intolerance to a class of medications, and the patient's response to prior therapies can help guide a practitioner in choosing the optimal treatment of pyoderma gangrenosum.

Adjuvants, Immunologic↗
PubMed1988

Chlamydia trachomatis: is it possible to reduce the number of infections after abortions?

In a study at the University Hospital in Trondheim during 1983, the frequency of Chlamydia trachomatis among women terminating their pregnancies was 8.2%. Younger women were infected by C. trachomatis at a more frequent rate than older women (p less than 0.001). Treatment of chlamydia-positive women was initiated within the first two weeks after the abortion. However, among women readmitted to the hospital, chlamydia-positive women showed a higher frequency of salpingitis than chlamydia-negative women (p less than 0.08). Preabortion examination for C. trachomatis and treatment of chlamydia-positive women by practitioners before the abortion is carried out, may reduce the postabortal frequency of salpingitis.

Abortion, Induced↗
PubMed1991

[Applications in gynecology-obstetrics of the first legal cases concerning HIV transmission by blood transfusion and errors in screening].

The intention of the authors in this paper is to provide a preliminary report on what is going on in order to inform gynaecologists and obstetricians of the initial legal steps concerning the transmission of HIV by blood transfusion and the defects in screening for the infection which could have been caught by a pregnant woman; where there was a possibility of a false-positive diagnosis from the serum which could have brought about a termination of pregnancy unnecessarily. Two decisions have been analysed, the one according to the old administrative law and the other according to the more recent judgement, involving pregnancy and other decisions which were not directly concerned with the specialty. These can be instructive for practitioners because these circumstance may come up again. It is worth looking at the case papers where medical responsibility can be invoked involving the professional insurance agencies. These cases will increase in numbers in the future. The authors analysed in the light of the decisions that had been made, possible penal, civil and administrative liabilities that could threaten gynaecologists and obstetricians in this field. The study ends by pointing out what can be done to lessen these medico-legal risks by avoiding blood loss in operations, by finding other ways than blood transfusions towards the end of pregnancy, but above all, by reducing and controlling the number of blood transfusions carefully. This has to be done in collaboration with the transfusion centres and the laboratories where the blood is tested. Judges will have to work out where the responsibility lies if the cases come before them.

Blood Transfusion↗
PubMed2000

Diagnosis of enteric disease in small ruminants.

Diagnosis of gastrointestinal disease in small ruminants requires integration of information obtained in the signalment, history, physical or necropsy examination, and ancillary diagnostic tests. The purpose of this article is to provide the practitioner with a review of the clinical features of several common gastrointestinal diseases of sheep and goats. Rumen acidosis, enterotoxemia, gastrointestinal parasitism, neonatal diarrhea, and salmonellosis are discussed, and where appropriate, reviews of the pathophysiology, prevention, and control of these diseases are cited for further reading.

Animals↗
PubMed2001

The increasing problem of hepatitis C virus infection.

The widespread incidence of hepatitis C (HCV) infection throughout the community is of concern. Although many of those infected will not suffer significantly from their infection, up to one-third will have liver disease, fatigue and oral health problems. General dental practitioners need to be aware of the precautions necessary in treating people with severe liver disease. This paper discusses the issues associated with treating patients who have HCV infection including the importance of preventive programs to reduce dental pathology and maximise oral health.

Antiviral Agents↗
PubMed1978

Control of trachoma and prevention of blindness in rural communities in Burma.

Trachoma was identified as the single most important cause of blindness in central Burma in a study carried out in 1961-1962. Control measures started in 1964 considerably reduced the degree of endemicity and severity of the disease in the areas treated. According to recent simplified criteria of evaluation, the prevalence of active trachoma has been reduced by more than 60% and that of active inflammatory disease of moderate and severe intensity from 7.4% to 1.8% of the active cases. A reduction in the risk of becoming infected is evident from changes that have occurred among the younger age groups.The experience acquired by the trachoma control project in central Burma-covering a population of more than 4 million in 8000 villages-emphasizes the importance of the active participation of the community and the role of local auxiliary personnel. Most of the activities, including surgical repair of trichiasis, are the responsibility of health assistants; their training includes, in addition to the recognition and treatment of patients requiring topical application of antibiotics or surgical repair of trichiasis, the screening and referral to the general practitioner or to the eye specialist of those needing more specialized attention.The results already obtained have made possible a gradual replacement of control activities by a surveillance programme, and their integration into the basic health services. The objectives of the trachoma control programme have been expanded to include the prevention and management of other causes of preventable or curable blindness, with special emphasis on eye injuries and glaucoma.

Adolescent↗
PubMed1998

Pilot study of six Colorado dental hygiene independent practices.

PURPOSE: The purpose of this pilot study was to gather demographic data about six Colorado dental hygienists who were practicing independently and their practices as well as assess productivity and service mix, evaluate structure and process, and compare the findings in these practices to those of a study of California Health Manpower Pilot Project #139. METHODS: A convenience sample of six dental hygiene independent practices was studied. A 21-item survey was distributed by mail to obtain demographic and practice information. Weekly surveys tracking patient visits and services provided were completed for three months. A general office audit to evaluate structure and a record audit of 22 patient records to evaluate process were conducted during visits at each practice site. The overall responses for each phase of this study were tabulated and frequencies were calculated using the SPSS/PC+ statistical package. RESULTS: The dental hygienists had practiced for an average of 13 years prior to establishing their practices. Four of the six practices were office-based, one was institution-based, and one was office- and institution-based. Health history, extraoral/intraoral examination, periodontal probing, adult prophylaxis, and oral hygiene instruction were provided during a majority of patient visits. The general office audit revealed compliance with infection control, office protocols for emergency situations, and practice management protocols. The patient record audit indicated a high standard for process of care for the practice sites. CONCLUSION: The six practices revealed a variety of backgrounds among the dental hygienists and diverse practice characteristics regarding both the populations served and practice settings. The services provided were consistent with allowable services for unsupervised practice. Compliance with specific guidelines was verified during the general office and patient record audits. Consistent with the findings of California Health Manpower Pilot Project #139, the care provided by the Colorado dental hygiene independent practitioners in this study and the environment in which the care was provided do not exhibit any undue risk to the health and safety of the public.

Adult↗