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PubMedDate not supplied

Nurses with blood-borne pathogens and the moral responsibilities of nurse regulating authorities.

This paper examines, for consideration by nurses and nurse regulating authorities (NRA), certain ethical and practice issues concerning registered/enrolled nurses with blood-borne pathogens (BBPs), such as Human Immunodeficiency Virus and Hepatitis Viruses. Under existing legislation, the identity and infectious status of a nurse with a BBP may be notified to a NRA by either a medical practitioner or another person. In the event of a notification being made, NRAs need to consider the question of how best to achieve a workable balance between protecting the significant moral interests of both the public and the nurse concerned. This paper clarifies how such a balance may be achieved, and provides recommendations on how the issue can be addressed in practice.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Variations in chemoprophylaxis for meningococcal disease: a retrospective case note review, analysis of routine prescribing data and questionnaire of general practitioners.

BACKGROUND: Invasive meningococcal disease is a significant cause of mortality and morbidity in the UK. Administration of chemoprophylaxis to close contacts reduces the risk of a secondary case. However, unnecessary chemoprophylaxis may be associated with adverse reactions, increased antibiotic resistance and removal of organisms, such as Neisseria lactamica, which help to protect against meningococcal disease. Limited evidence exists to suggest that overuse of chemoprophylaxis may occur. This study aimed to evaluate prescribing of chemoprophylaxis for contacts of meningococcal disease by general practitioners and hospital staff. METHODS: Retrospective case note review of cases of meningococcal disease was conducted in one health district from 1st September 1997 to 31st August 1999. Routine hospital and general practitioner prescribing data was searched for chemoprophylactic prescriptions of rifampicin and ciprofloxacin. A questionnaire of general practitioners was undertaken to obtain more detailed information. RESULTS: Prescribing by hospital doctors was in line with recommendations by the Consultant for Communicable Disease Control. General practitioners prescribed 118% more chemoprophylaxis than was recommended. Size of practice and training status did not affect the level of additional prescribing, but there were significant differences by geographical area. The highest levels of prescribing occurred in areas with high disease rates and associated publicity. However, some true close contacts did not appear to receive prophylaxis. CONCLUSIONS: Receipt of chemoprophylaxis is affected by a series of patient, doctor and community interactions. High publicity appears to increase demand for prophylaxis. Some true contacts do not receive appropriate chemoprophylaxis and are left at an unnecessarily increased risk.

Anti-Infective Agents↗

PubMed2004

The antimicrobial potential of 14 natural herbal dentifrices: results of an in vitro diffusion method study.

BACKGROUND: Increasing numbers of Americans are using natural herbal products for general and oral health care. Few of these products, however, have undergone rigorous testing, as evidenced by the limited amount of information on their safety and efficacy in the literature. The authors conducted an in vitro study to evaluate the antimicrobial potential of 14 natural herbal dentifrices. METHODS: The authors used a diffusion method to evaluate the antimicrobial effectiveness of 14 natural herbal dentifrices against four microorganisms: Streptococcus mutans, Streptococcus sanguis, Actinomyces viscosus and Candida albicans. Colgate Total (Colgate-Palmolive, New York City) and sterile pyrogen-free water served as the positive and negative controls, respectively. The authors tested the natural herbal dentifrices at full strength and at 1:1 dilution. They measured the zones of inhibition at 24 and 48 hours to evaluate the antimicrobial potential of the dentifrices. RESULTS: Six herbal dentifrices were effective in inhibiting the growth of all four microorganisms. The positive control produced significantly sized inhibition zones with all four microorganisms, while the negative control produced no observable zones. Six herbal dentifrices produced larger inhibition zones with A. viscosus than did the positive control. Six herbal dentifrices were inhibitory against C. albicans at full strength, but at 1:1 dilution, only three had such inhibitory effect. One herbal dentifrice produced microbial growth around and over the samples, indicating possible microbial contamination of the toothpaste. Only one herbal dentifrice showed consistent antimicrobial activity against all four microorganisms. CONCLUSIONS: The variation in antimicrobial inhibition among the herbal dentifrices indicates that more research is needed to validate their effectiveness claims. CLINICAL IMPLICATIONS: This study provides practitioners with insight into the claims of natural herbal dentifrices' antimicrobial effects.

Actinomyces viscosus↗

PubMed2006

Prolonged second stage of labor and risk of adverse maternal and perinatal outcomes: a systematic review.

BACKGROUND: Safe and effective management of the second stage of labor presents a clinical challenge for laboring women and practitioners of obstetric care. This systematic review was conducted to evaluate evidence for the influence of prolonged second stage of labor on the risk of selected adverse maternal and neonatal outcomes. METHODS: Articles were searched using PubMed, Cochrane Library, and CINAHL from 1980 until 2005. Studies were included according to 3 criteria: if they reported duration of the second stage of labor, if they reported maternal and/or neonatal outcomes in relation to prolonged second stage, and if they reported original research. RESULTS: Our systematic review found evidence of a strong association between prolonged second stage and operative delivery. Although significant associations with maternal outcomes such as postpartum hemorrhage, infection, and severe obstetric lacerations were reported, inherent limitations in methodology were evident in the studies. Recurrent limitations included oversimplified categorization of second stage, inconsistency in study population characteristics, and lack of control of confounding factors. No associations between prolonged second stage and adverse neonatal outcomes were reported. CONCLUSIONS: The primary findings of our review indicated that most of the studies are flawed and do not answer the important questions for maternity caregivers to safely manage prolonged second stage. Meanwhile, approaches for promoting a normal second stage of labor are available to caregivers, such as maternal positioning and pain relief measures and also promoting effective pushing technique.

Adult↗

PubMed1992

Effect of storage time with different lens care systems on in-office hydrogel trial lens disinfection efficacy: a multi-center study.

A combined prospective and retrospective study was conducted to evaluate the efficacy of in-office disinfection methods for hydrogel trial contact lenses. Two hundred and twenty-one trial contact lenses, disinfected by four different disinfection methods, were collected from seven Study Centers and cultured for microbial contamination after various storage periods. Negative and positive control lenses were included as an additional Center in this double-masked study. There was a significant difference in the incidence of microbial contamination among the Centers for all storage times (chi 2 p < 0.001). Contamination of trial lenses in Centers using thermal disinfection with preserved saline (SoftWear Saline) was negative and thermal disinfection with nonpreserved saline (LensPlus Saline) was 8.7%. Lens contamination in Centers using chemical disinfection was 13.6% with ReNu and 40.7% with OptiFree. The degree of contamination ranged from 90 colony forming units (CFU)/ml to over 10 million CFU/ml. Among the microorganisms isolated after the different disinfection methods were Alcaligenes xylosoxidans, Serratia marcescens, Moraxella phenylpyruvica, Enterobacter agglomerans, Pseudomonas stutzeri, and various gram-positive organisms. This study suggests that practitioners should redisinfect all inventory trial lenses at least once a month to minimize the risk of patient infection.

Bacteria↗

PubMedDate not supplied

Relative prevalence of rotavirus diarrhoea in children attending outpatient departments of hospitals and general practitioners in Sao Paulo, Brazil.

The study was done to know the relative prevalence of rotavirus diarrhoea in 329 children with diarrhoea aged less than 1 month to 6 years (32 were of unknown age) attending the outpatient departments (OPD) of public hospitals and 38 comparable patients treated by general practitioners (GP) in Sao Paulo, Brazil. Forty-three age-matched patients without any diarrhoea or respiratory symptoms, 28 from the hospital OPDs and 15 from the GPs, served as controls. Rotavirus was detected in 52 of the 329 (15.8%) patients attending hospital OPDs, and in 11 of the 38 (28.9%) patients attending GPs. Rotavirus was detected in the faecal sample of only one child from each of the two control groups getting treatment in the two facilities respectively. The proportion of patients, who attended the GPs showing only rotavirus and no pathogenic bacteria in their stools, was significantly (Chi-square test at the level of 5%) higher than that in similar patients attending the hospital OPDs. Patients aged 7 to 12 months showed the highest frequency (34%) of rotavirus positive stools. Of the 63 rotavirus positive cases, 19 had mixed infections with commonly occurring bacterial pathogens of the intestines.

Brazil↗

PubMed1996

[Cryptosporidia associated gastroenteritis: epidemiologic study of children in Tyrol and Vorarlberg].

Stool samples from 523 children aged between 3 months and 6 years were examined for Cryptosporidium parvum by means of the direct immunofluorescence technique in March 1996. The specimens were sent to the Federal Public Health Laboratory in Innsbruck from general practitioners and pediatricians and from hospitals in Tyrol and Vorarlberg. The study was performed during the cold season in an area that does not employ surface water for the production of drinking water. Oocysts of cryptosporidia were detected as the sole agent in 4 out of 294 samples (1.4%) taken from children suffering from diarrheal disease, as well as in 1 out of 229 samples (0.4%) of children in the control group. Duration of diarrheal disease varied from 2 days to 4 weeks. In addition, a 75 stool samples from Tyrolean calves were examined for cryptosporidia. Oocysts were detected in 3 out of 75 stool samples (4.0%). Routine examinations for Cryptosporidium parvum in stool specimens of immunocompetent children with diarrhea do not seem to be necessary in Western Austria during the cold season due to the self-limiting course of the infection.

Animals↗

PubMed1981

What to do until the FDA arrives.

The need for clinical monitoring to assure drug safety despite reliance on Food and Drug Administration testing is illustrated. The need to temper theory with clinical experience is exemplified by the recent examples of swine flu, resistant gonorrhea, and resistant pneumococcal infection. The potential for adverse effects to escape detection in animal studies and small-scale human trials is illustrated by the examples of ticrynafen, chloramphenicol, and diethylstilbestrol. The potential for unexpected side effects when established drugs are used in new ways is demonstrated by the examples of retrolental fibroplasia and vitamin D toxicity. The responsibilities of the medical profession and the individual practitioner include a healthy skepticism of newly introduced treatments, active participation in clinical monitoring, and maintenance of a system for chart retrieval when drugs are recalled or new effects reported.

Chloramphenicol↗

PubMed1995

Changes in symptoms, peak expiratory flow, and sputum flora during treatment with antibiotics of exacerbations in patients with chronic obstructive pulmonary disease in general practice.

BACKGROUND: Bacterial infections of the lower airways during an exacerbation in patients with asthma or chronic obstructive pulmonary disease (COPD) may be the cause of an exacerbation or the consequence of a viral infection or an increase in airways limitation. To determine whether bacterial infection is an important component in the pathogenesis of an exacerbation, the effects of antimicrobial treatment must be studied. METHODS: Patients with asthma or COPD seen in general practice were studied in a double blind randomised manner to investigate whether the antimicrobial drugs amoxicillin (500 mg three times daily), cotrimoxazole (960 mg twice daily), or a placebo, each when added to a short course of oral corticosteroids, can accelerate recovery from exacerbations. Patients were instructed to contact their own physician early in the morning when complaints of increased shortness of breath, wheezing, or exacerbations of cough with or without sputum production occurred. Treatment effects were evaluated over the next 14 days by studying symptom scores (wheeze, dyspnoea, cough with and without mucus production, and awakening with dyspnoea), peak expiratory flow values (PEF, expressed as % predicted), and sublingual temperature. Bacteriological study of the sputum was made at the onset of an exacerbation and 7, 21 and 35 days afterwards. RESULTS: Of 195 patients enrolled 71 (36%) contacted their physician for symptoms of an exacerbation. Symptoms improved in all three groups, improvements ranging from 0.54 to 0.75 points per day on a four point scale. PEF% predicted showed improvements in the three groups after the exacerbation, ranging from 0.34% to 0.78% predicted per day, finally returning to baseline values. Sublingual temperature did not change. Six of 71 patients consulted their physician because of a relapse between four and 24 days after the start of treatment. In only two of the 50 sputum samples, collected during an exacerbation, and which contained > or = 10(5) bacteria in culture sensitive to the chosen antibiotic given, did any benefit from antimicrobial treatment occur. During the recovery period sputum purulence improved irrespective of antibiotic treatment. CONCLUSIONS: Antibiotics given with a short course of oral prednisolone during an exacerbation do not accelerate recovery as measured by changes in peak flow and symptom scores in ambulatory patients with mild to moderate asthma or COPD when treated by their general practitioners. Moreover, antibiotics do not reduce the number of relapses after treating an exacerbation.

Amoxicillin↗

PubMed2003

How well do doctors know their patients with severe asthma?

BACKGROUND: Rates of asthma mortality have fallen in Australia since the commencement of the National Asthma Campaign and promotion of the Australian asthma management plan. New strategies are now needed to further reduce mortality. AIM: To examine agreement about key features between asthma patients and their general practitioners (GPs). METHODS: We interviewed: (i) the next of kin of 56 asthma deaths, (ii) 91 asthma patients presenting to emergency departments with acute severe asthma and (iii) 147 of their GPs. RESULTS: Agreement was substantial for usage of oral symptomatic medication, but poor for inhaled symptomatic and preventive medications. There was moderate agreement regarding hospital admissions within the last 12 months among the cases, but little about other markers of severity. There was moderate agreement where the presenting or fatal attack was triggered by an upper respiratory-tract infection or aspirin. The next of kin and GPs agreed about family problems, but not about other psychosocial issues. They also agreed about which cases had been given action plans or verbal instructions, but few other aspects of asthma management. There was also moderate agreement regarding the use of peak flow meters by the controls. CONCLUSIONS: Doctors often have relatively poor insights into self-management practices, social background or trigger factors, even in high-risk patients. This should be considered when planning future campaigns to improve asthma management and further reduce mortality.

Adult↗

PubMed2003

Overuse of high stability antibiotics and its consequences in public and environmental health.

In this paper the ecological aspects of widespread antibiotic consumption are described. Many practitioners, veterinarians, breeders, farmers and analysts work on the assumption that a antibiotics undergo spontaneous degradation. It is well documented that the indiscriminate use of antibiotics has led to the water contamination, selection and dissemination of antibiotic-resistant organisms, alteration of fragile ecology of the microbial ecosystems. The damages caused by the overuse of antibiotics include hospital, waterborne and foodborne infections by resistant bacteria, enteropathy (irritable bowel syndrome, antibiotic-associated diarrhea etc.), drug hypersensitivity, biosphere alteration, human and animal growth promotion, destruction of fragile interspecific competition in microbial ecosystems etc. The consequences of heavy antibiotic use for public and environmental health are difficult to assess: utilization of antibiotics from the environment and reduction of irrational use is the highest priority issue. This purpose may be accomplished by bioremediation, use of probenecid for antibiotic dosage reduction and by adoption of hospital infections methodology for control resistance in natural ecosystems.

Agriculture↗

PubMed1991

Vulvovaginal candidiasis: a study of immediate vs. delayed treatment on patient comfort.

Vulvovaginal candidiasis is a miserable infection that affects millions of women each year. The purpose of this article's study was to investigate the effectiveness of an immediate treatment intervention for increasing the comfort level of women with vulvovaginal candidiasis. An experimental study using a sample of 20 women compared the comfort of a control group, which received routine care, to the comfort of the experimental group, which received routine care plus vaginal debridement followed by application of vaginal medication. The experimental group experienced greater relief from their symptoms post-treatment than did the control group. Implications for NP practice are presented.

Adolescent↗

PubMed2001

In vitro studies on the immunomodulatory effects of extracts of Osbeckia aspera.

Ayruvedic medical practitioners in Sri Lanka use aqueous extracts of the mature leaves of Osbeckia aspera to treat liver disease. The extract has been shown to have hepatoprotective effects in vitro and in vivo, and to have inhibitory effects on the complement system and on in vitro phagocytosis by polymorphonuclear cells. The aim of this study was to investigate the effect of an aqueous extract of Osbeckia on lymphocyte proliferation stimulated by mitogens and antigen. In control peripheral blood mononuclear cells (PBMC), high concentrations of the Osbeckia extract were inhibitory to proliferation stimulated by phytohaemagglutinin (PHA) and tuberculin purified protein derivative (PPD). On stimulation by phorbol myristate acetate and ionomycin (PMA+I) the extract showed stimulation of proliferation at low concentrations (<10 microg/ml) with inhibition at higher concentrations. A similar inhibitory pattern on mitogen/antigen stimulation was seen with PBMC from patients with chronic hepatitis C virus (HCV) infection. These results suggest that the inhibitory agent(s) in the aqueous extract of Osbeckia may have an effect on antigen-presenting cell function. The combined hepatoprotective and immunosuppressive effects of the extract are more likely to be beneficial in acute hepatitis rather than chronic hepatitis viral infection.

Adjuvants, Immunologic↗

PubMed1994

Immediate transmucosal implants using the principle of guided tissue regeneration. I. Rationale, clinical procedures and 30-month results.

The installation of implants directly into extraction sockets offers considerable advantages over other treatment modalities for both practitioners and patients. Usually, immediate implants are placed and subsequently covered by mucosa allowing a submerged healing mode. This report presents the rationale, clinical procedures and results for immediate transmucosal implants. Following an intracrevicular incision and flap elevation, the tooth to be extracted is carefully luxated by means of small elevators to preserve the entire bony housing of the tooth. A titanium plasma-sprayed implant (ITI Bonefit) is then installed at the bottom or in the wall of the extraction socket. An expanded polytetrafluoroethylene barrier membrane (Gore-Tex GTAM) is tightly adapted around the implant post and over the bony margins of the alveolus. The flaps are then replaced, adapted around the neck of the implant and sutured. During nonsubmerged, transmucosal healing of the site, meticulous plaque control is performed by mechanical and chemical means. Membranes are removed after 5-7 months. Since infection was prevented, the implants obtained stability, healthy peri-implant mucosal tissues were observed and missing bone in the alveoli regenerated. Of 21 transmucosal implants placed into fresh extraction sockets, 20 yielded complete bone fill and coverage of the entire plasma-coated implants surface at the time of membrane removal. This documentation suggests that the immediate nonsubmerged installation of an implant into an extraction socket is a predictable treatment modality with good long-term prognosis.

Adult↗

PubMed2002

Monitoring techniques for diabetes mellitus in the dog and the cat.

One of the keys to achieving glycemic control in animals with diabetes mellitus is the appropriate selection and interpretation of analytic monitoring tests. Diabetic animals are subject to many of the same problems described in human diabetics. Diabetics are more susceptible to infection, and wound healing is often impaired. Decreased insulin promotes lipolysis and moderate hyperlipidemia, which can lead to falsely lowered fructosamine levels, impaired renal circulation, and atherosclerosis. Hyperglycemic, hypoinsulinemic animals continue to lose weight despite an increased appetite and an increased intake because they are not able to use glucose. Many unregulated diabetic animals will present with vomiting and diarrhea that can exacerbate electrolyte abnormalities seen with the osmotic diuresis present in an uncontrolled state. Canine diabetics are prone to cataract formation secondary to sorbitol accumulation in the lens. Cats, on the other hand, can present with diabetic distal neuropathy, which may be reversible with appropriate treatment. With all of these potential complications, it is important to monitor these animals regularly; this is the only way that glycemic control can be properly maintained over time. This article reviews the monitoring parameters available to the modern practitioner and outlines the benefits of each test, as well as caveats, in their interpretation.

Animals↗

PubMed2005

Costs of treatment of Swiss patients with HIV on antiretroviral therapy in hospital-based and general practice-based care: a prospective cohort study.

Some ambulant people with HIV are cared for primarily by their general practitioner and some in an outpatient clinic. Costs and patterns of care in these settings were studied in 65 such patients based in Zürich, from a limited societal perspective (excluding patient costs) based on medical resource use. Antiretroviral therapy (ART), other medications and patient variables were collected prospectively, and non-medication resources (professional time and investigations) and treatment history data were collected from medical records and by record linkage to the Swiss HIV Cohort Study database. Cost differences between the settings were estimated using multiple regression, controlling for differences in case-mix. ART comprised 80% of the total cost, non-medication costs 15% and non-ART medications 5%. Total costs were higher in the outpatient clinic (estimated additional cost after controlling for case-mix = 3489 Swiss Francs per year at 1999 prices, 95% confidence interval 742 to 6236, p=0.017). The difference was accounted for by higher ART costs in the outpatient clinic, not through a tendency to use more expensive drugs or higher doses but rather through the use of more drugs concurrently. Differences in ART prescribing patterns between the doctors in the outpatient clinic and the general practitioners were considerable and appear worthy of further investigation.

Adult↗

PubMed2000

[The chemiluminescence test in the laboratory evaluation of effects of immunostimulatory therapy].

BACKGROUND: Number of patients treated by general practitioners with various immunomodulatory drugs has recently increased. Effects of such medication on the immune system were not usually monitored. The aim of our work was to evaluate effect of selected immunomodulatory drugs on the phagocytic and metabolic activities of the phagocytes. METHODS AND RESULTS: 51 patients (18 males and 33 females) of the average age 36 years with repeating respiratory, mycotic and herpetic infections were investigated. Immunomodulatory treatment included: Decaris (Lavamizolum), Isoprinosine (Methisoprinolum), Imudon (Lysatum bacteriale mixtum), Biostim (Klebsiella pneumoniae), and Immodin (Leukocyti dialysati lyophylysatum). Before and after treatment all patients underwent basic immunological examination IgG, IgA, IgM, C3, C4 complement components, PEG, CD3, CD4, CD8 and CD19). Phagocytotic activity was estimated by means of FAGO MSHP test with HEMA particles and by chemiluminiscence test. Chemiluminiscence was measured using ML 3000 Microtiter Plate Luminometer (Dynex), 26 healthy individuals of the corresponding age were the controls. Results were statistically evaluated by Student's t-test. Significant increase of the cellular metabolic activity was found in Decaris and Immodin treated patients (P < 0.001). CONCLUSIONS: Chemiluminiscence test, which evaluates the metabolic activity of phagocytes, can be used for the accurate laboratory monitoring of the effects of some immunomodulatory drugs on the natural immunity of patients.

Adjuvants, Immunologic↗

PubMed1980

Determining the "proper" gentamicin dosage in a hospital setting.

A method for determining a gentamicin dosage was applied to a patient in a community hospital setting. It was found that many factors, some beyond the practitioner's control, confused proper use of the drug. A case is used to illustrate the difficulties encountered in a community hospital setting when a seemingly straightforward protocol for gentamicin administration for therapy was initiated. The errors associated with each of five levels of personnel are illustrated which if summed could result in potentially serious consequences. In addition to reviewing the literature on gentamicin dosage schedules and making recommendations regarding future research in this area, specific guidelines are proposed for the use of gentamicin in clinical practice.

Aged↗