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PubMedDate not supplied

A national survey of air medical infectious disease control practices.

INTRODUCTION: Caring for an infectious patient in the air medical environment presents a special challenge to all air crew members (ACMs) involved. The purpose of this study was to survey the infectious disease control practices of air medical programs (AMPs) that are members of the Association of Air Medical Services. METHODS: A structured telephone survey was designed to gather data. Using one interviewer (an undergraduate student) with no knowledge of the study's goal minimized experimental bias. AMPs from 151 geographically selected areas were called between June and August 1996. Only the programs' chief flight nurses (CFNs) were targeted as respondents. RESULTS: The response rate was 91% (138 of 151). Although no program refused to participate, 13 CFNs were unavailable to be interviewed. Mission profile was 32% scene and 68% interhospital with an annual average of 950 patient transports per program. Transport type was 61% rotor-wing aircraft, 17% fixed-wing, and 22% both. Flight physicals for ACMs were required by 57% of the AMPs. Pre-employment screenings for rubella, tuberculosis (TB), and varicella were noted. Interestingly, 17% of the AMPs reported pre-employment HIV testing. Immunization was mandated by 57% of AMPs, including hepatitis B virus, measles, rubella, and tetanus. Nine percent of the respondents refused to accept a transport with specific contagious conditions, primarily TB. A formal decontamination policy was in effect at 88% of the AMPs, and OSHA-approved filter masks were available at 70%. Pathogen exposure reporting was required by 97%. CONCLUSION: A current, comprehensive infection control program, continuing education, and 100% compliance with standard precautions will help reduce the possibility of accidental exposures. These strategies to reduce transmission also can be extended during training sessions to the prehospital and hospital personnel with whom the air medical program serves.

Air Ambulances↗

PubMed2004

What do negative associations between potential risk factors and illness in analytical epidemiological studies of infectious disease really mean?

In epidemiological studies of infectious diseases it is not unusual to find that some potential risk factors are negatively associated with risk of illness. The mechanisms generating these associations are unclear in many cases, though one explanation is immunity due to prior exposure. We derive mathematical models for the proportion of a population who are infected with a disease and the proportion who are susceptible in any year of life when individuals are at risk of exposure through more than one route. It is shown that risk of illness declines with increasing age and that this risk declines most rapidly in those groups at increased exposure. In high exposure groups, the relative risk of illness, compared to a group with lower exposure, also declines with age, eventually becoming less than one. The threshold age at which the relative risk is less than 1, i.e., factor B becomes protective decreases with higher exposure rates. Epidemiological studies may substantially underestimate the importance of risk factors where exposure is consistent over many years.

Adolescent↗

PubMed1998

Infectious disease of the spine: outcome of rehabilitation.

Infectious disease of the spine is infrequently seen in the rehabilitation setting. We examined retrospectively 26 patients with spinal infections admitted to the rehabilitation centre over a 6-year period to determine the demographic characteristics, clinical features and outcome after rehabilitation. Their ages ranged from 24 to 83 years (mean = 56.4); 65.4% were males. The infection was due to pyogenic bacteria in 14 patients (53.8%) and Mycobacterium tuberculosis in 12 (46.2%). Staphylococcus aureus was the causative agent in 69% of those with pyogenic infections. A history of diabetes mellitus was present in 35.7% of the pyogenic group but in only 8.3% of the tuberculous group. Localised back pain, fever and neurological deficits were the typical clinical manifestations. The most common site of infection was the thoracic region. Surgery was performed on 24 patients and all received prolonged courses of antibiotics. All but three patients completed the rehabilitation programme. The motor score for the lower limbs and the modified Barthel scores for activities of daily living (ADL) and mobility improved significantly (P < 0.05) for both pyogenic and tuberculous groups. The amounts of improvement achieved were not significantly different between the pyogenic and tuberculous groups except for ADL. Age, gender and the presence of diabetes mellitus did not appear to significantly affect the neurological or functional outcome in our study population. The majority of patients (87.5%) were discharged to their own homes.

Activities of Daily Living↗

PubMed2000

Findings of the 1998 Infectious Diseases Society of America membership survey.

The Infectious Diseases Society of America (IDSA) conducted a survey in 1998 to characterize its membership and to determine their needs. The response rate was 39%. Although only 23% of the respondents spent most of their time in the field of teaching and research, 62% of the respondents listed an academic institution as their primary employer. According to survey results, 17% of respondents indicated that care of HIV-infected patients comprised one-half or more of their practices. Respondents noted shortcomings in their training as a result of recent changes in the clinical practice arena and the health care system; more than one-fourth of the respondents identified deficits in their preparation for administration, infection control, pharmacoeconomics, quality assurance, transplantation, and outcomes research. This survey discloses that the IDSA membership perceives a need for changes in IDSA-sponsored fellowship training programs and graduate educational activities.

Adult↗

PubMed2004

Infectious disease images on the World Wide Web.

Infectious diseases (ID) physicians are often in need of medical images to enhance their teaching, research, and clinical practice. We explored the Internet for Web sites with images that would be useful to ID physicians. A total of 24 sites were included for review. Of these, 10 sites were broad in their scope and included images of bacteria, parasites, viruses, and/or fungi. In addition, 4 sites reviewed were specific for fungi, 4 sites were specific for viruses, and 6 sites focused on parasites. The number and size of images, copyright restrictions, and fees were noted for all sites. The authors gave each site a subjective navigation and layout score. Features of the sites, including microscopy images, laboratory images, clinical images, clinical vignettes, medical illustrations and/or clip art, medical illustrations of life cycles, slides of educational material, radiographs, and animation or video, were also described. A variety of image resources are available to the ID physician.

Communicable Diseases↗

PubMed1999

Fever without apparent source on clinical examination, lower respiratory infections in children, and other infectious diseases.

This section focuses on issues in infectious disease that are commonly encountered in pediatric office practice. Paul McCarthy discusses recent literature regarding the evaluation and management of acute fevers without apparent source on clinical examination in infants and children and the evaluation of children with prolonged fevers of unknown origin. Jean Klig reviews recent literature about lower respiratory tract infection in children. Finally, Jeffrey Kahn discusses recent developments concerning rotavirus vaccine.

Child↗

PubMed2000

Dental caries is a preventable infectious disease.

Dental caries is the most common infectious disease affecting humans. The principal causative agents are a group of streptococcal species collectively referred to as the mutans streptococci of which Streptococcus mutans and Streptococcus sobrinus are the most important agents of human caries. This review outlines what is currently known about these ubiquitous pathogens and discusses novel methods for elimination of these bacteria from dental plaque.

Adult↗

PubMed1993

An evaluation of the Northumberland Infectious Disease Report.

An evaluation of the quarterly Infectious Disease Report for Northumberland was undertaken by postal questionnaire. The response to the survey was encouraging, suggesting that this method of communicating local information is not only acceptable, but also effective and perceived as having a positive impact on practice.

Attitude of Health Personnel↗

PubMed1987

Antibiotic restriction programs and cephalosporin use in pediatrics: a survey of infectious disease specialists.

A survey of 105 pediatric infectious disease specialists was conducted to elicit opinions regarding antibiotic restriction programs and use of individual parenteral cephalosporins in pediatrics. Virtually all respondents favored antibiotic restriction programs, with 68% currently involved in these efforts. Unrestricted availability of cefazolin, cephalothin, cefoxitin, and cefuroxime was recommended by 83%, 72%, 58%, and 49%, respectively, of respondents. Restricted use of third-generation cephalosporins, including cefotaxime, cefoperazone, ceftizoxime, and moxalactam was generally recommended. Over 50% of respondents recommended the use of chloramphenicol plus ampicillin (or a penicillinase-resistant penicillin), while 21.9% advocated the use of cefuroxime as empiric therapy to treat the increasing number of H. influenzae species resistant to ampicillin in infants outside the neonatal period and in young children.

Anti-Bacterial Agents↗

PubMedDate not supplied

Actinomycosis of the ano-rectum: a rare infectious disease mimicking carcinomatosis.

Abdominal actinomycosis is an infectious disease caused by Actinomyces israeli, a usual germ of the gastro intestinal tract. It gives unusual tumoral lesions with abcesses and fistulas. More rarely is abdominal actinomycosis at the end of the abdominal tube. Cope in 1949 said: "Actinomycosis occurs so seldom in the colon and the rectum that no surgeon, even if he be a proctologist is likely in a life time to see more than a few cases" (4). An anorectal actinomycosis case that looked like rectal cancer is reported. It was treated successfully by surgery and antibiotherapy. Some anatomopathologic and mainly histologic characteristics lead to the diagnosis. General and pathological aspects, symptoms, diagnosis, differential diagnosis and therapy of anorectal actinomycosis are discussed.

Actinomycosis↗

PubMed1978

[The role of prevention of infectious diseases in health maintenance].

The prophylaxis of infectious diseases is one of the triumphs of medical science. In examining the role and the responsibility of the physician in this activity the author emphasizes the importance of fundamental research (in the laboratory and the clinic), the need to employ prophylactic measures which are known to be effective, and, finally, the obligation of individual physicians and organized medicine to assume responsibility for problems which extend beyond their national boundaries. The encouragement of preventive medicine depends, among other factors, upon the development of a strong personal relationship between patient and physician. The current system for the remuneration of physicians hinders this relationship instead of promoting it.

Anti-Bacterial Agents↗

PubMed1984

[Clinical and bacteriological efficiency of sulbactam/cefoperazone in gynecological infectious diseases].

The combined antibiotics, sulbactam/cefoperazone (SBT/CPZ), was administrated intravenously to 10 patients with various kinds of gynecological infectious diseases and the efficiency of the drug was investigated clinically or bacteriologically. The results obtained were as follows. The clinical and bacteriological efficiency rate of SBT/CPZ on gynecological infectious diseases was determined as about 100 per cent and 75 per cent. Three species out of 11 isolated bacteria produced beta-lactamase. Two cases out of 3 beta-lactamase positive bacteria were disappeared in the materials obtained from the patients after the treatment of the drug. No remarkable side effect except for 1 buccal exanthema and 1 genital candidiasis was detected during the administration course of the drug.

Adult↗

PubMed2005

Serendipity and new drugs for infectious disease.

Serendipity, in various shades of semantic legitimacy, is abundantly evident in the history of the chemotherapy of infectious disease. We may be on the threshold of a new era of rational drug design, but most medications for infectious diseases have arisen, and continue to arise, from chance observation, clinical experience, and the empirical search for substances active against pathogens. Chance does not produce drugs; but where chance has played a pivotal role in drug discovery, the event may be considered serendipitous to a greater or lesser degree. In a deliberate search for new drugs, it is often difficult to assess the degree to which any resulting discovery is serendipitous, and the usefulness of the term becomes debatable. Many therapeutic advances emerge from research involving animals, and a triggering "happy accident" may reside in the most basic aspects of animal care or in the most arcane knowledge of animals. The examples discussed in this article deal mostly with parasitic disease and the use of animal models in the discovery of antiparasitic agents. In this area, as in others, chance has laid the groundwork for scientific advancement and practical benefit. Although the applicability of the word serendipity to drug discovery may often be uncertain, the role played by chance should be recognized and welcomed.

Animals↗

PubMed2004

Chip-mediated techniques: how close are we to generalised use in the infectious disease clinic?

This could be the beginning of a new molecular era for the diagnosis of infectious diseases. Biological chips (biochips or microarrays and labchips) offer a potentially important shortcut to early diagnosis and treatment. It is also possible to develop multiplex assays for use in complex diagnostic situations; however, this technology depends crucially on the robotics developed to support these functions, and the soundness of the mathematics employed to analyse the output. Although the number of research applications is increasing, the question as to when, or if, chip-mediated techniques will be used routinely in the infectious disease clinic remains unanswered at present.

Communicable Diseases↗

PubMed1998

Community-acquired pneumonia in adults: guidelines for management. The Infectious Diseases Society of America.

This is part of the series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of this guideline is to provide assistance to clinicians in the diagnosis and treatment of community-acquired pneumonia. The targeted providers are internists and family practitioners. The targeted groups are immunocompetent adult patients. Criteria are specified for determining whether the inpatient or outpatient setting is appropriate for treatment. Differences from other guidelines written on this topic include use of laboratory criteria for diagnosis and approach to antimicrobial therapy. Panel members and consultants are experts in adult infectious diseases. The guidelines are evidence based where possible. A standard ranking system is used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary and tables highlight the major recommendations. The guidelines will be listed on the IDSA home page at http://www.idsociety.org.

Adult↗

PubMed1997

Quality standards for immunization. Guidelines from the Infectious Diseases Society of America.

This is the third in a series of guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. It is presented as a standard of care rather than a practice guideline because the case for following these recommendations is very strong and it should be followed with rare exceptions. The purpose of this guideline is to provide assistance to clinicians when making decisions on providing immunizations to healthy infants, children, and adults. The document is a summary of guidelines already developed by national organizations. The targeted providers are pediatricians, family practitioners, internists, and other physicians who provide immunizations. The IDSA provided the funding. Panel members represent experts in adult and pediatric infectious diseases. The guidelines are evidence-based. A standard ranking system is used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary and tables highlight the major recommendations. Indicators for measuring compliance with the standards are included.

Adolescent↗

PubMed2003

Promising immunotherapies with Th1-related cytokines against infectious diseases.

In recent years, there has been an increase in the number of individuals with compromised immune systems. This is due to the rise in the numbers of aging people, patients receiving immunosuppressive treatment after organ transplantation, patients with hematological malignancies, and patients with AIDS. These individuals frequently fall into helper T cell (Th)1-Th2 cytokine imbalance due to a shift towards a Th2-dominant condition. Such a pathological condition puts them at a high risk for developing infectious diseases caused by a variety of microbial pathogens which are often refractory to conventional chemotherapy. Therefore, the administration of Th1-related cytokines is expected to be promising immunotherapy against these intractable infectious diseases. In a series of investigations, we have demonstrated the effectiveness of treatment with Th1-related cytokines, such as interferon (IFN)-gamma, interleukin (IL)-12, and IL-18, in protecting animals from experimental infectious diseases caused by Mycobacterium tuberculosis and Cryptococcus neoformans. Recently, several investigators reported successful clinical treatment with IFN-gamma or IL-12 in patients with intractable tuberculous and nontuberculous mycobacteriosis. Thus, now is an appropriate time for scientific evaluation to clinically confirm the effectiveness of these novel immunotherapies.

Communicable Diseases↗

PubMed2004

Isolation versus quarantine and alternative measures to control emerging infectious diseases.

In the past 25 years, the world has witnessed the emergence and re-emergence of many infectious diseases. In the early stages of their emergence, isolation and quarantine may be the only and last resort to effectively control infectious diseases when we are confronted with limited or no knowledge of a newly identified and previously unknown contagious disease, which causes a serious public health threat either locally or internationally. The article traces back the origins of isolation and quarantine; defines precisely the terms isolation and quarantine as they are currently used in the modern era; compare and contrast these terms; identifies some of the harmful consequences of applying quarantine measures; highlights considerations for the use of isolation and quarantine; and identifies alternative measures adopted by the world health community to respond to emerging and re-emerging health threats.

Communicable Disease Control↗