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PubMed2001

A 2-step non-surgical procedure and systemic antibiotics in the treatment of rapidly progressive periodontitis.

BACKGROUND: In the last few years knowledge about periodontal infections has increased enormously, nevertheless practitioners are still seeking guidelines for suitable treatment concepts. METHODS: The aim of this study was to examine the effect of doxycycline, metronidazole, and clindamycin used adjunctively in a 2-step nonsurgical procedure in patients with rapidly progressive periodontitis (RPP). The first step included scaling, root planing, and polishing (SRP) in each quadrant using 4 to 5 visits. The second step included full-mouth enhanced root planing (RP) and wound dressing in 1 or 2 visits after SRP and the beginning of antibiotic therapy. Forty-eight patients (mean age 32.4 years) with generalized RPP, with an average of 16 sites with probing depths (PD) deeper than 8 mm, and high counts of Porphyromonas gingivalis were randomly assigned to 4 different groups: group 1 (doxycycline) n = 12, group 2 (metronidazole) n = 15, group 3 (clindamycin) n = 11, and group 4 (control group; no antibiotic treatment) n = 10. Clinical evaluations, including plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), clinical attachment level (CAL), and bacteriological and crevicular cell sampling, were done at baseline (BL), 3 weeks after SRP, and 6 and 24 months after RP. RESULTS: After the first step (SRP), we observed an improvement of PI and SBI in all 4 groups, but did not see any statistically significant PD reduction 3 weeks after SRP compared to baseline. However, 6 and 24 months after the second step (RP) we observed a significantly greater reduction of PD in groups 2 and 3 and a significantly greater CAL gain in comparison to groups 1 and 4. After 24 months, the attachment level gain in group 1 and group 4 was less than 1.5 mm, and less than 1.0 mm in PD site categories 6 to 9 mm and >9 mm. PI showed no significant difference between the groups throughout the period after SRP until 24 months, compared to 3 weeks after SRP. SBI decreased most in the metronidazole and clindamycin groups. P. gingivalis and Actinobacillus actinomycetemcomitans were almost completely eradicated in these 2 groups 24 months after RP. In addition, the phagocytotic capacity of crevicular polymorphonuclear neutrophils was increased in groups 2 and 3 after the second step. CONCLUSIONS: The present results show that metronidazole and clindamycin are effective antibiotics when used adjunctively in a 2-step nonsurgical procedure of scaling and root planing in RPP patients.

Adult↗
PubMed2003

Survey of general practitioner satisfaction with a district communicable disease control service.

General practitioners (GPs) have an important role in disease surveillance and control, and are therefore a key target audience for a district communicable disease control (CDC) service. The feedback of surveillance information, and the provision of policies, guidance and specialist advice, are essential functions of a CDC service. This survey was undertaken to assess how well a CDC service was meeting the needs of GPs. Satisfaction with the service was assessed using a questionnaire survey of 166 GPs. The response rate was 42%. GPs reported a high level of overall satisfaction. The service was valued and it influenced GP practice. The service was valued more for responses to requests for information and assistance than for communicable disease control policies. The highest satisfaction was expressed for communication and for immunisation advice. Several areas of need were identified, including the need for surveillance information on antibiotic resistance and for sexually transmitted infections. The survey tool is recommended as a way of auditing standards for Good Public Health Practice, as identified by the Faculty of Public Health Medicine.

Attitude of Health Personnel↗
PubMed1997

[Otitis externa among users of private swimming pools].

The purpose of this study was to detect risk factors for developing otitis externa (OE) with special regard to swimming in private pools in holiday houses. Data were collected in a retrospective case-control study from June to October in 1993 and over the same period in 1994. Patients who had OE diagnosed by a general practitioner were included. In 1993 controls were 134 guests from 27 holiday houses where nobody got o.e. during their stay. The number of cases was 35. In 1994 the design was changed so that controls were the 95 healthy inhabitants from the same houses as the 23 cases. The amounts of time spent in the pools and the total bacteria count in the water were significant risk factors for developing OE. Pseudomonas aeruginosa was found in 80% of the ear swabs of the casegroup. In 1993 30% and in 1994 83% of the pools fulfilled the requirements for public pools set by the Danish authorities.

Adult↗
PubMed1994

Self-esteem, problem solving, and sexual risk behavior among women with and without Chlamydia.

Self-esteem and problem-solving appraisal were evaluated as an explanation of sexual risk behavior for the sexually transmitted disease (STD), chlamydia. Chlamydia, the most prevalent bacterial STD in the United States, is linked to a variety of problems which affect women, their offspring, and their sex partners. Data were collected by two nurse practitioners during scheduled gynecology visits for 105 military women. There was a statistical association among women with chlamydia (chi 2 = 3.623, df = 1, p = .057) and trichomonas (chi 2 = 12.83, df = 1, p = < .001) and a friable cervix. With a 10% prevalence of chlamydia, accurate diagnosis and treatment are imperative. No differences between the prevalence of chlamydia and self-esteem and problem-solving appraisal were noted. These findings support the strategies for diagnoses, treatment, and prevention of chlamydia recommended by the Centers for Disease Control.

Adult↗
PubMed2001

Seroprevalence of human granulocytic ehrlichiosis in high-risk groups in Denmark.

The aim of this study was to evaluate the seroprevalence of human granulocytic ehrlichiosis (HGE) among 300 residents in the county of Funen, Denmark. All of these people had either suspected or confirmed borreliosis. Two hundred control sera were included in the study. Samples were submitted by general practitioners and by hospital departments. An indirect immunofluorescence assay was used to identify sera reactive to HGE and an enzyme-linked immunosorbent assay was used to analyse Borrelia burgdorferi antibodies. There were 63 (21%) HGE-positive sera, 53 of which came from Borrelia-seropositive patients. Among patients with negative Borrelia serology, but with clinical suspicion of borreliosis, 14.3% were HGE-positive (n = 70). Of the 200 control sera, 3.5% were HGE-positive and 10.5% were Borrelia-positive. No HGE-positive samples were found among subjects < 20 y of age, wheras 20.4% of Borrelia seropositive samples where from subjects < 20 y of age. No mortality was observed in the HGE-positive group and the percentage of serum samples positive for both Borrelia and HGE did not differ significantly between hospitalized and non-hospitalized patients. Our study indicates that HGE infection with or without concomitant or previous Borrelia burgdorferi infection is common in tick-exposed individuals > 20 y old in the county of Funen, Denmark.

Adolescent↗
PubMed1997

Antibiotic prophylaxis and open groin hernia repair.

Antibiotic prophylaxis is not routinely given for nonimplant, clean operations, although this view has recently been challenged. We have conducted a randomized multicenter, double-blind prospective trial to compare co-amoxiclav with placebo in 619 patients undergoing open groin hernia repair. Altogether 563 (91%) patients fulfilled the protocol; 283 received co-amoxiclav and 280 placebo. There was no difference between the groups in the number of patients receiving local or general anesthetic, the type of repair performed, the use of a subcutaneous fat suture, the type of skin closure used, the use of wound analgesia, or the use of a wound drain. Patients were given a card to return to the hospital in the event of their wound discharging or their needing to see their general practitioner. All patients were reviewed at approximately 6 weeks after operation. Fifty (8.9%) patients sustained a wound infection, 25 in the co-amoxiclav group and 25 in the placebo group. We conclude that antibiotic prophylaxis is of no benefit to patients undergoing open groin hernia repair.

Adult↗
PubMed1999

Some current obstetric and gynaecological problems.

It has never been right to practise obstetrics and gynaecology in a purely mechanistic style. Medical practitioners have always discussed and argued, often driven by their patients, both the ethical framework and the individual circumstantial detail of practice within this specialty. This chapter starts by discussing the place of ethics and minimum core values for practice. Their integration into every doctor-patient relationship must be taught from the earliest training. It is not possible to catalogue every circumstance within the specialty where there are ethical problems to be addressed. Principles are outlined and many examples within the context of routine general specialty practice including aspects of pregnancy and fertility control are considered.

Abortion, Legal↗
PubMed1999

Inadequate treatment for sexually transmitted diseases in the South African private health sector.

Correct management of sexually transmitted diseases (STDs) is important for their control, and to reduce HIV transmission. Guidelines on syndromic management of STDs were introduced by the provincial Department of Health in KwaZulu/Natal (KZN) in South Africa in 1995. The drug treatment provided for STDs by the 11 private general practitioners in one rural district was assessed and compared with provincial guidelines. Information was gathered through semistructured interviews which asked the 11 doctors, who all dispense prescribed drugs as part of the consultation fee, how they would treat 3 hypothetical cases of STD syndromes. In all 33 prescriptions, the treatment did not correspond exactly with provincial recommendations and only 3 (9%) were adequate. All other prescriptions were inadequate because dose or duration was incorrect in 6 (18%), or because incorrect drugs were prescribed in 24 (73%) of cases. Eight of the 11 doctors did not provide adequate treatment for any of their cases. A continuing medical education programme for the doctors and their staff was devised to improve the STD treatment in the private sector in this South African district.

Adult↗
PubMed1994

Pediatricians' diagnostic approach to pharyngitis and impact of CLIA 1988 on office diagnostic tests.

OBJECTIVE: To determine the factors associated with an optimal diagnostic approach to a child with pharyngitis, characterize office laboratory methods for throat swab culture and group A streptococcal rapid antigen testing, and assess the potential impact of the Clinical Laboratory Improvement Amendments (CLIA) of 1988 on the performance of these tests. DESIGN AND SETTING: Mailed survey to all board-certified primary care pediatricians from seven western states with telephone follow-up for nonrespondents. OUTCOME MEASURES: Differences in practice characteristics and use of office laboratory tests for physicians who usually (> 80%) diagnose pharyngitis using a recommended approach vs those who follow this approach less often (< 50%); characteristics of physicians who indicate that they intend to discontinue office throat culture because of CLIA and those who will continue to perform this test also are compared. RESULTS: Responses from 531 pediatricians were analyzed. Forty-four percent diagnosed pharyngitis appropriately for more than 80% of patients, and 17% did so for fewer than 50%. Optimal diagnosis was significantly more common among physicians who cultured throat swabs in their office (relative risk, 1.40; 95% confidence interval, 1.19 to 1.66) and less common among solo practitioners (relative risk, 0.71; 95% confidence interval, 0.56 to 0.88). Factors that may decrease the sensitivity of office throat culture include short duration of incubation (59%), lack of quality control (51%), and limited education of the persons reading results (6%). With implementation of CLIA, 24% of pediatricians reported that they already have discontinued or will discontinue office throat culture, and 23% have discontinued or will discontinue antigen detection testing for group A streptococci. Those most likely to stop office culture include solo practitioners and practitioners who do not currently perform quality control of culture methods. CONCLUSIONS: Office culture for group A streptococci is strongly associated with an optimal diagnostic approach. Implementation of CLIA regulations may substantially decrease the number of physicians who perform this test. The balance between potential improvements in the quality of office culture with CLIA implementation and the decreased availability of this test needs to be assessed.

Antigens, Bacterial↗
PubMed1994

Use of gloves among dentists in Sweden--a 3-year follow-up study.

150 community dentists and 200 private general dental practitioners in southern Sweden were asked about the frequency of glove use in dental practice and related issues. This was a 3-year follow-up study. 76% of the community GDPs and 29% of the private GDPs used gloves regularly in all patient treatment. The group consisted mostly of female and younger dentists. Dentists never using gloves at all were older, male private practitioners. Difficulties to adjust using gloves and mostly non-risk-clientele were the two main reasons for dentists not to use gloves regularly. Skin complaints related to glove use seems to have increased from 1988 to 1991. Cross-infection-risk by HIV from patient was assessed as low although the main reason for most dentist to use gloves regularly was the contemporary debate about AIDS and HIV in media.

Adult↗
PubMed2005

[A case of autochthonous early summer meningoencephalitis in Mecklenberg-Western Pomerania].

HISTORY: A 61-year-old man was bitten by a tick at Lake Woblitz, near the town of Neustrelitz in former East Germany. Nine days later he saw his general practitioner because of fever and headache. Three weeks after the tick bite he was hospitalized with fever (39.2 degrees C) and mental confusion. Because he had taken a Nile cruise six months earlier, malaria was considered and he was transferred to the department of tropical medicine and infectious diseases of the University of Rostock. INVESTIGATIONS: The patient was somnolent, his speech was slurred, and he had amnesic aphasia, as well as impaired fine motor control, but no meningism, focal signs, pyramidal tract or sensory impairment. Cerebrospinal fluid (CSF) showed mild lymphocytosis (9,400 leukocytes per microL; 89% lymphocytes) and elevated protein concentration (1322 mg/L) with blood brain barrier impairment and intrathecal IgM synthesis. Anti-tick-bite encephalitis (TBE) antibodies (ELISA: IgG and IgM) were present in serum and CSF, and serum immunofluorescence showed an eight-fold titer increase within two weeks. These findings confirm the diagnosis of TBE. Other infections (including those with cross-reacting flaviviruses) were excluded by appropriate antibody testing. THERAPY AND CLINICAL COURSE: There is no specific antiviral treatment for TBE, but on symptomatic therapy the patient recovered fully within four weeks. CONCLUSION: The site of the patient's infection is located 10 km to the west of an old TBE focus, but no TBE virus had been detected there after 1975. The case demonstrates that TBE should be included in the differential diagnosis of meningoencephalitis, even if the patient has not been in an acknowledged TBE endemic area.

Animals↗
PubMed1980

Assessment of the morbidity and value of prophylactic cephazolin sodium in urinary tract instrumentation in out-patients.

A pilot study showed that following urinary tract endoscopy in out-patients there is a significant incidence of subsequent rigor and general practitioner call-out. A double-blind study was carried out in 690 consecutive patients to assess the effectiveness of prophylactic doses (1 g) of cephazolin, given intravenously or intramuscularly at the time of the procedure, compared with no treatmemnt or placebo. The results, assessed from replies to a questionnaire, showed that whereas cephazolin given intravenously did not affect the incidence of subsequent rigor there was a significant reduction compared with controls when the antibiotic was given in the same dose intramuscularly.

Cefazolin↗
PubMed1990

Influence of human immunodeficiency virus infection on reproductive decisions.

This article discusses the role of the practitioner in the pregnancy decision-making process of the HIV-infected woman. Literature on women's decisions is reviewed, and variables that influence decisions are discussed. The author concludes that HIV infection does not have a significant impact on pregnancy decisions. Other cultural and psychosocial variables may have more importance.

Attitude to Health↗
PubMed1997

Sexual health promotion and nursing.

The HIV epidemic provides continued impetus for effective sexual health promotion. Sexual health promotion in nursing practice has traditionally been equated to prevention at primary, secondary and tertiary levels. Increasing demands on practitioners to address the psycho-social aspects of sexual health, together with a greater emphasis on primary prevention, is leading to the adoption of theoretical paradigms from the behavioural sciences and the increasing use of counselling skills. The limitations of individualist interventions for primary prevention are explored, and the assumption that health care professionals are effective promoters of sexual health is questioned. The importance of placing sexual health and nursing practice within a wider social, political and cultural context is emphasized.

HIV Infections↗
PubMed1994

Salivary diagnosis of measles: a study of notified cases in the United Kingdom, 1991-3.

OBJECTIVES: To validate a method for salivary diagnosis of measles and to assess the diagnostic accuracy of notified cases of measles. DESIGN: Blood and saliva samples were collected within 90 days of onset of symptoms from patients clinically diagnosed as having measles and tested for specific IgM by antibody capture radioimmunoassay. SETTING: 17 districts in England and one in southern Ireland during August 1991 to February 1993. SUBJECTS: 236 children and adults with measles notified by a general practitioner. RESULTS: Specific IgM was detected in serum in only 85 (36%) of the 236 cases. In cases associated with outbreaks and tested within six weeks of onset, 53/57 (93%) of samples were IgM positive, thereby confirming the sensitivity of serum IgM detection as a marker of recent infection. The serological confirmation rate was lower in cases with a documented history of vaccination (13/87; 15%) than in those without (70/149; 47%) and varied with age, being lowest in patients under a year, of whom only 4/36 (11%) were confirmed. Measles specific IgM was detected in 71/77 (92%) of adequate saliva samples collected from patients with serum positive for IgM. In cases where measles was not confirmed, 6/101 had rubella specific IgM and 5/132 had human parvovirus B19 specific IgM detected in serum. CONCLUSIONS: The existing national surveillance system for measles, which relies on clinically diagnosed cases, lacks the precision required for effective disease control. Saliva is a valid alternative to serum for IgM detection, and salivary diagnosis could play a major role in achieving measles elimination. Rubella and parvovirus B19 seem to be responsible for a minority of incorrectly diagnosed cases of measles in the United Kingdom and other infectious causes of measles-like illness need to be sought.

Adolescent↗
PubMedDate not supplied

Real-time polymerase chain reaction: a novel molecular diagnostic tool for equine infectious diseases.

The focus of rapid diagnosis of infectious disease of horses in the last decade has shifted from the conventional laboratory techniques of antigen detection, microscopy, and culture to molecular diagnosis of infectious agents. Equine practitioners must be able to interpret the use, limitations, and results of molecular diagnostic techniques, as they are increasingly integrated into routine microbiology laboratory protocols. Polymerase chain reaction (PCR) is the best-known and most successfully implemented diagnostic molecular technology to date. It can detect slow-growing, difficult-to-cultivate, or uncultivatable microorganisms and can be used in situations in which clinical microbiology diagnostic procedures are inadequate, time-consuming, difficult, expensive, or hazardous to laboratory staff. Inherent technical limitations of PCR are present, but they are reduced in laboratories that use standardized protocols, conduct rigid validation protocols, and adhere to appropriate quality-control procedures. Improvements in PCR, especially probe-based real-time PCR, have broadened its diagnostic capabilities in clinical infectious diseases to complement and even surpass traditional methods in some situations. Furthermore, real-time PCR is capable of quantitation, allowing discrimination of clinically relevant infections characterized by pathogen replication and high pathogen loads from chronic latent infections. Automation of all components of PCR is now possible, which will decrease the risk of generating false-positive results due to contamination. The novel real-time PCR strategy and clinical applications in equine infectious diseases will be the subject of this review.

Animals↗
PubMed2000

Randomised placebo controlled trial of nebulised corticosteroids in acute respiratory syncytial viral bronchiolitis.

OBJECTIVE: To evaluate short and long term effects of giving nebulised budesonide early in respiratory syncytial viral (RSV) bronchiolitis. DESIGN: A multicentre randomised double blind placebo controlled trial. SUBJECTS: Infants admitted to hospital with their first episode of RSV positive bronchiolitis. INTERVENTION: Randomisation to receive either 1 mg of nebulised budesonide (Bud) or placebo (Pla) twice daily from admission until 2 weeks after discharge. Follow up was for 12 months. MAIN OUTCOME MEASURES: Duration of hospital admission, time taken to become symptom free, re-admission rates, general practitioner consultation rates, and use of anti-wheeze medication during follow up. RESULTS: 161 infants were studied. Both arms were similar with respect to initial clinical severity, age, sex, socioeconomic class, and tobacco exposure. Median time from first nebulisation to discharge: Bud and Pla, 2 days. Median number of days for 50% of infants to be symptom free for 48 hours: Bud, 10 days; Pla, 12 days. Respiratory re-admission rates in the 12 month follow up: Bud, 16%; Pla, 18%; median difference (95% confidence interval (CI)), -2 (-14 to 10). Median respiratory related general practitioner attendances: Bud, 4.0; Pla, 4.5; median difference (95% CI), -1 (-2 to 0). Percentage of infants receiving at least one prescription for anti-wheeze medication during follow up, corticosteroids: Bud, 50%; Pla, 60%; difference (95% CI), -10 (-26 to 6); bronchodilators: Bud, 60%; Pla, 67%; difference (95% CI), -7 (-22 to 8). CONCLUSIONS: There are no short or long term clinical benefits from the administration of nebulised corticosteroids in the acute phase of RSV bronchiolitis.

Acute Disease↗
PubMedDate not supplied

Are Irish General Practitioners minimising infection risk from sharps?

A self administered postal questionnaire was sent to a computer randomised sample of 200 GPs registered with the Irish College of General Practitioners. The objective of this was to determine if Irish GPs are minimising infection risk from sharps, by observing current phlebotomy techniques, current sharps disposal methods and by availing of Hepatitis B vaccination. The response rate was 69% (n = 138). Phlebotomy technique: syringes and needles were used by 55% and the vacutainer system by 34% with 11% using both methods. Of note, 50% of G.P.s usually recapped needles and 57% never wore gloves. Only 48% of G.P.s had been vaccinated against Hepatitis B. More recently qualified G.P.s were more likely to be vaccinated. Many Irish G.P.s have unsafe phlebotomy practices. There is inadequate use of specifically designed impenetrable sharps boxes, with no standard method of either collection or disposal of used sharps. Uptake of Hepatitis B vaccination is low. Amongst Irish G.P.s, there is a gap between the perceived and the actual safety of sharps disposal methods in use. No protocol advising G.P.s on infection control exists. We recommend that guidelines regarding safe phlebotomy technique, sharps disposal and the importance of Hepatitis B vaccination be produced and strongly reinforced, and that within each health board there is a standard policy and procedure established for collection and disposal of used sharps. The above are essential for the health and safety for both G.P.s and the public.

Family Practice↗