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Audits of medical records were done for similar one-month periods in 1974 and 1977 in a 125-bed community hospital in Hawaii to determine patterns of antibiotic use. One quarter of all hospital patients in both study periods received antibiotics. In 1977 cephalosporins, ampicillin and aminoglycosides were the most commonly used antibiotics. Half of the antibiotics used by surgical specialty departments in both periods were for prophylactic indications. The cost of antimicrobial prophylaxis per patient was reduced by about 57 percent in 1977 compared with 1974. In the 1977 period, 58 percent of patients received proper prophylactic antibiotic regimens; this was statistically higher than the 15 percent of patients given appropriate prophylactic antibiotics in 1974. Fewer than half of the patients in both study periods treated for infections received correct antibiotic therapy. In contrast, 82 percent of infectious disease consultations were considered appropriate by an independent specialist in infectious disease. However, these consultations were obtained in only 15 percent of the patients who received therapeutic antibiotics. It was concluded that audits of patients receiving antibiotics can be effective in the development of appropriate prophylactic surgical regimens. However, during the study period in 1977, we were not able to show large scale improvement in therapeutic antimicrobial use at this community hospital, either by our attempts at physician education or by making infectious disease consultations available. 相似文献
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OBJECTIVE--To see whether non-professional volunteer community mothers could deliver a child development programme to disadvantaged first time mothers for children aged up to 1 year. DESIGN--Randomised controlled trial. SETTING--A regional health authority in Dublin. SUBJECTS--262 first time mothers who were delivered during six months in 1989 and who lived in a deprived area of Dublin; 30 experienced mothers from the same community recruited as community mothers. INTERVENTIONS--All the first time mothers received standard support from the public health nurse. In addition, those in the intervention group received the services of a community mother, who was scheduled to visit monthly during the first year of the child''s life. RESULTS--232 (89%) first time mothers completed the study--127 in the intervention group, 105 controls. At the end of the study children in the intervention group were more likely to have received all of their primary immunisations, to be read to, and to be read to daily, played more cognitive games; and were exposed to more nursery rhymes. They were less likely to begin cows'' milk before 26 weeks and to receive an inappropriate energy intake and inappropriate amounts of animal protein, non-animal protein, wholefoods, vegetables, fruit, and milk. Mothers in the intervention group also had a better diet than controls. At the end of the study they were less likely to be tired, feel miserable, and want to stay indoors; had more positive feelings; and were less likely to display negative feelings. CONCLUSION--Non-professionals can deliver a health promotion programme on child development effectively. Whether they can do so as effectively as professionals requires further study. 相似文献
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Prokesová L Novotná O Janatková I Zanvit P Zizka J Lodinová-Zádníková R Kocourková I Sterzl I 《Folia microbiologica》2008,53(1):67-72
IgE against mixtures of common food or respiratory allergens were determined by ELISA in healthy (n = 38) and allergic (n = 62) mothers and their children. Significantly higher level of IgE against respiratory allergens was found in sera of allergic mothers and in cord blood of their children. No correlation between antibody level in maternal and newborn's sera was found; this argues against the transfer of IgE from mother to fetus and points rather to offspring's intrauterine sensitization. Specific IgE level in cord blood was higher in children who developed later allergy than in children who did not. Specific IgE level in colostrum was low both in healthy and allergic mothers; there was no correlation between high concentration of IgE against respiratory allergens in sera of allergic mothers and their colostrum, which does not support the idea of IgE transport from blood to mammary gland. Only slightly increased colostral IgE was detected in allergic mothers whose children manifested allergy later. Allergy of the mother and high level of anti-allergen IgE in her serum and in cord blood are the main predictive factors of future occurrence of allergy in the offspring. A combination of several predictive factors could have higher prognostic value. 相似文献
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The efficacy of endolymphatic route of gentamicin and ceporin administration was studied in 89 patients with neurosurgical pathological processes complicated by acute pneumonia (80 patients) and meningoencephalitis (9 patients) usually after ineffective antibiotic therapy according to the routine methods. The antibiotics were used in accordance with the antibiograms of the causative agents isolated from the bronchial tree or CSF. The endolymphatic use of gentamicin or ceporin once a day in doses of 80 mg or 1 g respectively provided rapid sanation and arresting of the inflammatory foci, lowering of the intoxication level, more rapid promotion of the positive time course of the clinico-roentgenological and laboratory indices and decreasing of the recovery periods by 1.5-2 times in 86 per cent of the patients with pneumonia. The endolymphatic administration of gentamicin in a dose of 80 mg twice a day or ceporin in a dose of 1 g twice a day allowed one to maintain the antibiotic therapeutic levels in the cerebrospinal fluid and to obtain satisfactory clinical results in the combined treatment of meningoencephalitis. The endolymphatic administration of the drugs was well tolerated by the patients and no adverse reactions were observed. This route of administration of antibiotics and in particular broad spectrum antibiotics may be recommended for urgent antibacterial therapy of especially severe neurosurgical patients with pyo-inflammatory complications and patients who did not respond to the routine antibiotic therapy. 相似文献
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Gordon H. Hawks 《CMAJ》1965,93(16):848-853
The antibiotic treatment of staphylococcal infections remains a problem. Isolation of the organism and sensitivity testing are necessary in the choice of antibiotic. Penicillin G is the most effective penicillin against non-penicillinase-producing staphy-lococci; for the penicillinase producers there is very little to choose between the semisynthetic penicillins, methicillin, cloxacillin, nafcillin and oxacillin. For patients who are hypersensitive to penicillin, the bacteriostatic drugs (erythromycin, novobiocin, tetracycline, chloramphenicol, oleandomycin) are useful for mild infections, while for more severe illness the bactericidal drugs (vancomycin, ristocetin, kanamycin, bacitracin, neomycin) have been used successfully. Acute staphylococcal enterocolitis is probably best treated by a semisynthetic penicillin. Other antibiotics which have been found useful, with clinical trials, for staphylococcal infections are cephalosporin, fucidin, cephaloridine and lincomycin. The latter drug has been reported of value in the treatment of osteomyelitis. There is little justification for the prophylactic use of antibiotics to prevent staphylococcal infection. Surgical drainage is still an important adjunct in the treatment of many staphylococcal infections. 相似文献
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Hilary Bower Sembia Johnson Mohamed S. Bangura Alie Joshua Kamara Osman Kamara Saidu H. Mansaray Daniel Sesay Cecilia Turay Francesco Checchi Judith R. Glynn 《PLoS neglected tropical diseases》2016,10(4)
Background
Young children who contract Ebola Virus Disease (EVD) have a high case fatality rate, but their sources of infection and the role of breastfeeding are unclear.Methods/Principal Findings
Household members of EVD survivors from the Kerry Town Ebola Treatment Centre in Sierra Leone were interviewed four to 10 months after discharge to establish exposure levels for all members of the household, whether or not they became ill, and including those who died. We analysed a cohort of children under three years to examine associations between maternal illness, survival and breastfeeding, and the child’s outcome. Of 77 children aged zero to two years in the households we surveyed, 43% contracted EVD. 64 children and mothers could be linked: 25/40 (63%) of those whose mother had EVD developed EVD, compared to 2/24 (8%) whose mother did not have EVD, relative risk adjusted for age, sex and other exposures (aRR) 7·6, 95%CI 2·0–29·1. Among those with mothers with EVD, the risk of EVD in the child was higher if the mother died (aRR 1·5, 0·99–2·4), but there was no increased risk associated with breast-feeding (aRR 0·75, 0·46–1·2). Excluding those breastfed by infected mothers, half (11/22) of the children with direct contact with EVD cases with wet symptoms (diarrhoea, vomiting or haemorrhage) remained well.Conclusion/Significance
This is the largest study of mother-child pairs with EVD to date, and the first attempt at assessing excess risk from breastfeeding. For young children the key exposure associated with contracting EVD was mother’s illness with EVD, with a higher risk if the mother died. Breast feeding did not confer any additional risk in this study but high risk from proximity to a sick mother supports WHO recommendations for separation. This study also found that many children did not become ill despite high exposures. 相似文献13.
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To examine the association between different consulting styles in general practice (defined according to the average length of doctor-patient contact time in surgery consultations) and the process of care for those patients presenting with new episodes of respiratory illness, 1787 consultations conducted by 85 general practitioner principals in Lothian from November 1987 to May 1988 were analysed. Short as against long consultations resulted in less attention being given to psychosocial issues that the doctor recognised as relevant. When psychosocial problems were dealt with prescribing of antibiotics decreased. In this volunteer sample of doctors the process of care seemed to reflect decisions as to how time was allocated rather than inherently different patterns of clinical behavior. Organisational and contractual changes will shift the mix of financial and professional incentives for general practitioners in ways that could lead to doctors reallocating their time toward shorter consultations; such a reallocation could have important implications for patient care. 相似文献
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J. Macfarlane J. Prewett D. Rose P. Gard R. Cunningham P. Saikku S. Euden S. Myint 《BMJ (Clinical research ed.)》1997,315(7117):1206-1210
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K. G. Nicholson J. Kent V. Hammersley E. Cancio 《BMJ (Clinical research ed.)》1996,313(7065):1119-1123
OBJECTIVE: To assess the role of rhinoviruses in elderly people living in the community. DESIGN: Prospective community based surveillance of elderly people, without intervention. Subjects were telephoned weekly to identify symptomatic upper respiratory tract infections. Symptoms and impact of illnesses were monitored, and specimens were collected for diagnostic serology and human rhinovirus polymerase chain reaction. SETTING: Leicestershire, England. SUBJECTS: 533 subjects aged 60 to 90. MAIN OUTCOME MEASURES: Symptoms, restriction of activity, medical consultations, and antibiotic use during 96 rhinovirus infections. Adjusted odds ratios for lower respiratory syndromes with respect to smoking and health status. RESULTS: A viral cause was established in 211 (43%) of 497 respiratory illnesses; rhinoviruses were identified in 121 (24%) and as single pathogens in 107. The median duration of the first or only rhinovirus infection in the 96 people with 107 rhinovirus infections was 16 days; 18 of the 96 patients were confined to bed and 25 were unable to cope with routine household activities. Overall, 60 patients with rhinovirus infections had lower respiratory tract syndromes; 41 patients consulted their doctor, 31 of them (76%) receiving antibiotics. One patient died. Logistic regression analysis showed that chronic medical conditions increased the estimated probability of lower respiratory rhinovirus illness by 40% (95% confidence interval 17% to 68%) and smoking by 47% (14% to 90%). There were almost six times as many symptomatic rhinovirus infections as influenza A and B infections. CONCLUSIONS: Rhinoviruses are an important cause of debility and lower respiratory illness among elderly people in the community. Chronic ill health and smoking increase the likelihood of lower respiratory complications from such infections. The overall burden of rhinovirus infections in elderly people may approach that of influenza. 相似文献
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N Maskrey J F Poppleton D J Knowelden L C Grahame 《BMJ (Clinical research ed.)》1985,290(6481):1551-1553
Between 1 May and 30 September 1983 a practice of three doctors in the centre of Scarborough conducted 1772 consultations with 1472 temporary residents, 967 (55%) of which were during July and August. The pattern of illness differed considerably from that usually found in general practice, with an excess of minor infections, gastrointestinal upsets, and skin problems comprising 46% of the consultations. Practitioners who care for appreciable numbers of temporary residents should plan their services to match the special needs of holidaymakers. The task of doctors in areas with many visitors would be made easier if patients who are on regular medication or are under surveillance brought with them not only enough drugs for their needs but also a summary of their medical history. 相似文献
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K Torpey J Mandala P Kasonde G Bryan-Mofya M Bweupe J Mukundu C Zimba C Mwale H Lumano M Welsh 《PloS one》2012,7(8):e42859