RESUMEN
BACKGROUND: Escherichia coli bacteraemia rates in the UK have risen; rates are highest among older adults. Previous urinary tract infections (UTIs) and catheterization are risk factors. AIM: To examine effectiveness of behavioural interventions to reduce E. coli bacteraemia and/or symptomatic UTIs for older adults. METHODS: Sixteen databases, grey literature, and reference lists were searched. Titles and/or abstracts were scanned and selected papers were read fully to confirm suitability. Quality was assessed using Critical Appraisal Skills Programme guidelines and Scottish Intercollegiate Guidelines Network grading. FINDINGS: Twenty-one studies were reviewed, and all lacked methodological quality. Six multi-faceted hospital interventions including education, with audit and feedback or reminders reduced UTIs but only three supplied statements of significance. One study reported decreasing catheter-associated UTI (CAUTI) by 88% (F (1,20) = 7.25). Another study reported reductions in CAUTI from 11.17 to 10.53 during Phase I and by 0.39 during Phase II (χ2 = 254). A third study reported fewer UTIs per patient week (risk ratio = 0.39). Two hospital studies of online training and catheter insertion and care simulations decreased CAUTIs from 33 to 14 and from 10.40 to 0. Increasing nursing staff, community continence nurses, and catheter removal reminder stickers reduced infection. There were no studies examining prevention of E. coli bacteraemias. CONCLUSION: The heterogeneity of studies means that one effective intervention cannot be recommended. We suggest that feedback should be considered because it facilitated reductions in UTI when used alone or in multi-faceted interventions including education, audit or catheter removal protocols. Multi-faceted education is likely to be effective. Catheter removal protocols, increased staffing, and patient education require further evaluation.
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Bacteriemia/prevención & control , Terapia Conductista/métodos , Infecciones por Escherichia coli/prevención & control , Control de Infecciones/métodos , Infecciones Urinarias/prevención & control , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Factores de Riesgo , Reino Unido , Infecciones Urinarias/complicacionesAsunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Infecciones por Escherichia coli/microbiología , Escherichia coli/efectos de los fármacos , Infecciones Urinarias/microbiología , Orina/microbiología , Preescolar , Inglaterra/epidemiología , Monitoreo Epidemiológico , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/epidemiología , Femenino , Humanos , Lactante , Masculino , Prevalencia , Infecciones Urinarias/epidemiologíaRESUMEN
Faecal samples from 1365 healthy asymptomatic volunteers from four regions in England were screened for the presence of Clostridium difficile between December 2013 and July 2014. The carriage rate of C. difficile in healthy patients was 0.5%, which is lower than reported previously. This study demonstrates that the true community reservoir of C. difficile in the healthy UK population is very low and is, therefore, unlikely to be a reservoir for infections diagnosed in the hospital setting.
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Portador Sano/microbiología , Infecciones por Clostridium/epidemiología , Clostridium/aislamiento & purificación , Heces/microbiología , Adulto , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/diagnóstico , Inglaterra/epidemiología , Voluntarios Sanos , Humanos , Reacción en Cadena de la Polimerasa , Medicina Estatal , Adulto JovenRESUMEN
BACKGROUND: Chlamydia trachomatis (chlamydia) is the most commonly diagnosed sexually transmitted infection (STI) in England; approximately 70% of diagnoses are in sexually active young adults aged under 25. To facilitate opportunistic chlamydia screening in general practice, a complex intervention, based on a previously successful Chlamydia Intervention Randomised Trial (CIRT), was piloted in England. The modified intervention (3Cs and HIV) aimed to encourage general practice staff to routinely offer chlamydia testing to all 15-24 year olds regardless of the type of consultation. However, when the 3Cs (chlamydia screening, signposting to contraceptive services, free condoms) and HIV was offered to a large number of general practitioner (GP) surgeries across England, chlamydia screening was not significantly increased. This qualitative evaluation addresses the following aims: a) Explore why the modified intervention did not increase screening across all general practices. b) Suggest recommendations for future intervention implementation. METHODS: Phone interviews were carried out with 26 practice staff, at least 5 months after their initial educational workshop, exploring their opinions on the workshop and intervention implementation in the real world setting. Interview transcripts were thematically analysed and further examined using the fidelity of implementation model. RESULTS: Participants who attended had a positive attitude towards the workshops, but attendee numbers were low. Often, the intervention content, as detailed in the educational workshops, was not adhered to: practice staff were unaware of any on-going trainer support; computer prompts were only added to the female contraception template; patients were not encouraged to complete the test immediately; complete chlamydia kits were not always readily available to the clinicians; and videos and posters were not utilised. Staff reported that financial incentives, themselves, were not a motivator; competing priorities and time were identified as major barriers. CONCLUSION: Not adhering to the exact intervention model may explain the lack of significant increases in chlamydia screening. To increase fidelity of implementation outside of Randomised Controlled Trial (RCT) conditions, and consequently, improve likelihood of increased screening, future public health interventions in general practices need to have: more specific action planning within the educational workshop; computer prompts added to systems and used; all staff attending the workshop; and on-going practice staff support with feedback of progress on screening and diagnosis rates fed back to all staff.
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Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/aislamiento & purificación , Medicina Familiar y Comunitaria/organización & administración , Medicina General/estadística & datos numéricos , Tamizaje Masivo/organización & administración , Adolescente , Adulto , Infecciones por Chlamydia/epidemiología , Inglaterra/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVES: To assess and compare the implementation of antimicrobial stewardship (AMS) interventions recommended within the national AMS toolkits, TARGET and Start Smart Then Focus, in English primary and secondary healthcare settings in 2014, to determine the prevalence of cross-sector engagement to drive AMS interventions and to propose next steps to improve implementation of AMS. METHODS: Electronic surveys were circulated to all 211 clinical commissioning groups (CCGs; primary sector) and to 146 (out of the 159) acute trusts (secondary sector) in England. Response rates were 39% and 63% for the primary and secondary sectors, respectively. RESULTS: The majority of CCGs and acute trusts reported reviewing national AMS toolkits formally or informally (60% and 87%, respectively). However, only 13% of CCGs and 46% of acute trusts had developed an action plan for the implementation of these toolkits. Only 5% of CCGs had antimicrobial pharmacists in post; however, the role of specialist antimicrobial pharmacists continued to remain embedded within acute trusts, with 83% of responding trusts having an antimicrobial pharmacist at a senior grade. CONCLUSIONS: The majority of healthcare organizations review national AMS toolkits; however, implementation of the toolkits, through the development of action plans to deliver AMS interventions, requires improvement. For the first time, we report the extent of cross-sector and multidisciplinary collaboration to deliver AMS interventions in both primary and secondary care sectors in England. Results highlight that further qualitative and quantitative work is required to explore mutual benefits and promote best practice. Antimicrobial pharmacists remain leaders for implementing AMS interventions across both primary and secondary healthcare sectors.
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Antiinfecciosos/uso terapéutico , Utilización de Medicamentos/normas , Política de Salud , Atención Primaria de Salud/métodos , Atención Secundaria de Salud/métodos , Estudios Transversales , Inglaterra , Adhesión a Directriz , Investigación sobre Servicios de Salud , HumanosRESUMEN
OBJECTIVES: Sexually transmitted infections, HIV and unplanned pregnancies continue to be a major public health problem in England, especially in young adults. Strengthening the provision of free condoms, HIV testing, chlamydia screening and contraception within primary care will contribute to reducing poor sexual and reproductive health outcomes. Recent research demonstrated the benefit for general practices of educational support visits based on behaviour change theory. Public Health England (PHE) has piloted an educational training programme to improve the delivery of sexual health services and HIV testing within general practice. STUDY DESIGN & METHODS: The 3Cs & HIV programme used practice based workshops to improve staffs' awareness and skills in order to increase opportunistic offers of chlamydia testing, provision of contraceptive service information and free condoms (the '3Cs') to 15-24 year olds and HIV testing according to national guidelines. The programme was based on the theory of planned behaviour and has been implemented using a stepped wedge design. Process evaluation, testing and diagnosis data, plus qualitative interviews were all used in the evaluation. The primary outcome measures were chlamydia testing and diagnosis rates. Secondary outcome measures were HIV testing and diagnoses rates within each practice and rates of consultations where long acting reversible contraceptives had been discussed. CONCLUSION: A key strength of the 3Cs & HIV programme has been the evidence base underpinning the development of the resources and the formal process evaluation of its implementation. The programme was designed to encourage sustainable relationships between general practice staff and local sexual health services as well as the knowledge, awareness and behaviours cultivated during the programme.
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Protocolos Clínicos , Medicina General , Servicios de Salud Reproductiva , Educación Sexual , Adolescente , Infecciones por Chlamydia/prevención & control , Condones , Anticoncepción , Inglaterra , Infecciones por VIH/prevención & control , Humanos , Tamizaje Masivo , Adulto JovenRESUMEN
BACKGROUND: Most patients are prescribed Helicobacter pylori treatment without culture and antibiotic susceptibility testing, as current guidance recommends that patients with recurrent dyspepsia should be tested for H. pylori using a non-invasive breath or faecal antigen test. AIMS: To determine the prevalence of H. pylori antibiotic resistance in patients attending endoscopy in England and Wales, and the feasibility of an antibiotic resistance surveillance programme testing. METHODS: We tested the antibiotic susceptibility of H. pylori isolates from biopsy specimens from 2063 of 7791 (26%) patients attending for endoscopy in Gloucester and Bangor, and 339 biopsy specimens sent to the Helicobacter Reference Unit (HRU) in London. Culture and susceptibility testing was undertaken in line with National and European methods. RESULTS: Helicobacter pylori were cultured in 6.4% of 2063 patients attending Gloucester and Bangor hospitals. Resistance to amoxicillin, tetracycline and rifampicin/rifabutin was below 3% at all centres. Clarithromycin, metronidazole and quinolone resistance was significantly higher in HRU (68%, 88%, 17%) and Bangor isolates (18%, 43%, 13%) than Gloucester (3%, 22%, 1%). Each previous course of these antibiotics is associated with an increase in the risk of antibiotic resistance to that agent [clarithromycin: RR = 1.5 (P = 0.12); metronidazole RR = 1.6 (P = 0.002); quinolone RR = 1.8 (P = 0.01)]. CONCLUSIONS: Helicobacter pylori infection is now uncommon in dyspeptic patients at endoscopy. A surveillance system is feasible and necessary to inform dyspepsia management guidance. Clinicians should take a thorough antibiotic history before prescribing metronidazole, clarithromycin or levofloxacin for H. pylori.
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Antibacterianos/uso terapéutico , Farmacorresistencia Microbiana/efectos de los fármacos , Dispepsia/tratamiento farmacológico , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Claritromicina/uso terapéutico , Endoscopía , Inglaterra , Femenino , Humanos , Levofloxacino , Masculino , Metronidazol/uso terapéutico , Pruebas de Sensibilidad Microbiana/métodos , Ofloxacino/uso terapéutico , Factores de Riesgo , GalesRESUMEN
The objective of this study was to investigate the management of suspected fungal nail infections by general practitioners (GPs) and determine whether guidance is sought when submitting specimens for investigation or treating cases. Questionnaires were sent to all GPs (n = 2420) served by five Health Protection Agency (HPA) collaborating laboratories in the South West of England. A total of 769 GPs responded - topical and oral antifungals were never used by 29% and 16% of GPs respectively. When antifungals were prescribed, topicals were normally given because of the severity of infection (32%); Amorolofine (53%) was the preferred choice. Oral antifungals were most often prescribed after receipt of a laboratory report (77%); Terbinafine was the preferred choice (86%). Seventy percent of GPs would only treat a suspected nail infection with oral antifungals after sending a sample for investigation, yet 27% never waited for a microscopy report before prescribing oral antifungal treatment. GPs routinely send specimens from suspected fungal nail infections for microbiological investigation, yet treatment is often prescribed before a result is received. With clinical signs of fungal infections often non-specific, GPs should rely on laboratory results before prescribing expensive and lengthy antifungal treatments. Laboratories could further reduce antifungal use by including guidance on microscopy and culture reports.
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Onicomicosis/microbiología , Manejo de Especímenes/métodos , Adulto , Antifúngicos/uso terapéutico , Femenino , Médicos Generales/psicología , Humanos , Masculino , Persona de Mediana Edad , Onicomicosis/diagnóstico , Onicomicosis/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Encuestas y Cuestionarios , Reino UnidoAsunto(s)
Faringitis/microbiología , Juego de Reactivos para Diagnóstico/normas , Manejo de Especímenes/instrumentación , Infecciones Estreptocócicas/diagnóstico , Streptococcus pyogenes/aislamiento & purificación , Humanos , Sistemas de Atención de Punto , Sensibilidad y Especificidad , Manejo de Especímenes/normasRESUMEN
This twelfth best practice review examines four series of common primary care questions in laboratory medicine: (i) antiepileptic drug monitoring; (ii) infectious diarrhoea; (iii) methicillin resistant Staphylococcus aureus; and (iv) brain natriuretic peptide. The review is presented in question-answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.
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Anticonvulsivantes/sangre , Diarrea/microbiología , Monitoreo de Drogas/métodos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Péptido Natriurético Encefálico/análisis , Humanos , Tamizaje Masivo/métodos , Atención Primaria de Salud/métodos , Manejo de Especímenes/métodos , Infecciones Estafilocócicas/microbiologíaRESUMEN
The aim of this study was to investigate the prevalence and associated risk factors of methicillin-susceptible and methicillin-resistant Staphylocccus aureus (MSSA and MRSA) carriage in care homes, with particular focus on dementia. A point-prevalence survey of 748 residents in 51 care homes in Gloucestershire and Greater Bristol was undertaken. Dementia was assessed by the clock test or abbreviated mini-mental test. Nasal swabs were cultured for S. aureus on selective agar media. Multivariable analysis indicated that dementia was not a significant risk factor for MSSA (16.2%) or MRSA (7.8%); and that residents able to move around the home unassisted were at a lower risk of MRSA (P=0.04). MSSA carriage increased with increasing age (P=0.03) but MRSA carriage decreased with increasing age (P=0.05). Hospitalization in the last 6 months increased the risk of MSSA (P=0.04) and MRSA (P=0.10). We concluded that cross-infection through staff caring for more dependent residents may spread MRSA within care homes and from the recently hospitalized. Control of MSSA and MRSA in care homes requires focused infection control interventions.
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Portador Sano/epidemiología , Infección Hospitalaria/epidemiología , Demencia , Hogares para Ancianos , Casas de Salud , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/aislamiento & purificación , Anciano , Anciano de 80 o más Años , Portador Sano/microbiología , Infección Hospitalaria/microbiología , Femenino , Humanos , Masculino , Nariz/microbiología , Prevalencia , Factores de Riesgo , Reino UnidoRESUMEN
OBJECTIVE: To investigate microbiology laboratory reporting policies, whether practitioners working in primary care adhered to the relevant guidelines when submitting swabs from venous leg ulcers (VLUs), and the impact of laboratory reports on antibiotic usage forVLUs. METHOD: Questionnaires were sent to all microbiology laboratories in England and Wales, and to clinicians who had submitted VLU swabs to one laboratory. RESULTS: Ninety-five (47%) laboratories responded. Laboratories processed a mean of 7.3 leg ulcer swabs/100,000 population/week but were often unable to identify the leg ulcer aetiology from the clinical details provided. All laboratories stated that they routinely reported group A haemolytic streptococci and meticillin-sensitive and resistant Staphylococcus aureus; 75% always reported antibiotic susceptibility for these isolates. The majority reported other beta-haemolytic streptococci. A total of 126 clinicians (64%) returned their questionnaires; 100 had confirmed in their swab submission that the ulcer was of venous aetiology and so were included in the analysis. Eighty per cent of the swabs were submitted in accordance with guidelines, with increased pain (61%) being the most common reason. Discharge/exudate (52%) and malodour (41%) were common reasons for swab submissions, even though the guidelines do not cite them as clinical signs of infection. Reporting of antibiotic susceptibilities was associated with increased antibiotic usage. CONCLUSION: Clinicians in primary care generally adhere to guidelines when submittingVLU specimens for microbiological investigation. Clinicians need to include clinical information with the swab so that laboratories can interpret the microbiology results. To reduce the use of antibiotics in the management ofVLUs, laboratories need to be selective in their organism and antibiotic-susceptibility reporting.
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Adhesión a Directriz , Técnicas Microbiológicas/normas , Pautas de la Práctica en Medicina , Úlcera Varicosa/microbiología , Infección de Heridas/prevención & control , Antibacterianos/uso terapéutico , Notificación de Enfermedades , Inglaterra , Humanos , Control de Infecciones/normas , Laboratorios , Atención Primaria de Salud , Manejo de Especímenes , Gales , Infección de Heridas/diagnóstico , Infección de Heridas/tratamiento farmacológicoRESUMEN
OBJECTIVES: To explore strategies used by chlamydia screening co-ordinators and practice staff to implement genital chlamydia screening within general practices. METHODS: Qualitative phenomenological study using individual semi-structured telephone interviews. Screening co-ordinators were selected purposively in Phase 1 and 2 areas of the Department of Health National Chlamydia Screening Programme in England, where there was significant screening in general practice. Open questions were asked about: the factors that determined high chlamydia screening rates; maintaining motivation for screening; and strategies to increase screening in general practices. RESULTS: Co-ordinators reported that successful screening practices had a champion who drove the screening process forward. These practices had normalized screening, so all at-risk patients were offered opportunistic screening whenever they attended. This was facilitated by a variety of time-saving methods including computer prompts, test kits in the reception area, youth clinics and receptionist involvement. Chlamydia screening was sustained through frequent reminders, newsletters containing chlamydia screening rates, and advertising to the 'at-risk' population from the screening team. Co-ordinators' enthusiasm and project management skills were as important as sexual health experience. Co-ordinators reported that to facilitate chlamydia screening across all practices, screening could be included in the General Medical Services (GMS) contract, and a higher national profile was needed amongst health professionals and the public. CONCLUSIONS: All practice staff need to be encouraged to become champions of the chlamydia screening programme through education, especially aimed at older clinicians and receptionists. The National Health Service should consider including chlamydia screening in the GMS contract. Increased public awareness will allow screening to be undertaken more quickly and by non-medical staff.
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Infecciones por Chlamydia/diagnóstico , Medicina Familiar y Comunitaria/métodos , Pautas de la Práctica en Medicina , Adolescente , Infecciones por Chlamydia/prevención & control , Inglaterra , Femenino , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Planes de Incentivos para los Médicos , Sistemas Recordatorios , Adulto JovenRESUMEN
This ninth best-practice review examines two series of common primary care questions in laboratory medicine: (i) potassium abnormalities and (ii) venous leg ulcer microbiology. The review is presented in question-and-answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.
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Hiperpotasemia/diagnóstico , Hipopotasemia/diagnóstico , Úlcera de la Pierna/microbiología , Atención Primaria de Salud/métodos , Técnicas Bacteriológicas , HumanosRESUMEN
OBJECTIVES: To determine whether patients with an uncomplicated community-acquired urinary tract infection (UTI) and an isolate resistant to trimethoprim had worse clinical outcomes following empirical treatment with trimethoprim 200 mg twice daily for 3 days than did those with a susceptible isolate. PATIENTS AND METHODS: This was a prospective cohort study of clinical outcome. We enrolled 497 women (>or=18-70 years) presenting to general practitioner surgeries in Norwich and Gloucester with at least two symptoms of acute (<7 days) uncomplicated UTI. Significant bacteriuria was defined as >or=10(4) cfu/mL from a mid-stream urine (MSU). RESULTS: Of enrolled patients 75% (334/448) had significant bacteriuria, and trimethoprim resistance was present in 13.9% (44/317) of isolates. Patients with resistant isolates had a longer median time to symptom resolution (7 versus 4 days, P=0.0002), greater reconsultation to the practice (39% versus 6% in first week, P<0.0001), more subsequent antibiotics (36% versus 4% in first week, P<0.0001) and higher rates of significant bacteriuria at 1 month (42% versus 20% with susceptible isolate, P=0.04). Half of patients reconsulting in the first week had a resistant organism. CONCLUSIONS: Patients with uncomplicated UTI caused by trimethoprim-resistant organisms had significantly worse clinical outcomes than those with trimethoprim-susceptible organisms. Nevertheless, trimethoprim resistance was rarer than predicted from routine laboratory submissions and we calculate that 23 women require microbiological investigation to prevent one reconsultation arising from resistance-based treatment failure. We therefore suggest empirical antibiotic treatment in acute, uncomplicated UTIs. If patients reconsult in the first week, we suggest a change of antibiotic treatment with urine culture and susceptibility testing then done. More generally, laboratory resources should concentrate on resistance surveillance to inform empirical antibiotic choice.
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Antiinfecciosos/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Atención Primaria de Salud , Resistencia al Trimetoprim , Trimetoprim/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Enfermedad Aguda , Adulto , Anciano , Antiinfecciosos/farmacología , Estudios de Cohortes , Femenino , Humanos , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Trimetoprim/farmacologíaRESUMEN
This fourth best practice review examines four series of common primary care questions in laboratory medicine are examined in this review: (1) safety monitoring for three common drugs; (2) use of prostate-specific antigen; (3) investigation of vaginal discharge; and (4) investigation of subfertility. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of the guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most of them are consensus based rather than evidence based. They will be updated periodically to take account of new information.
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Patología Clínica/métodos , Atención Primaria de Salud/métodos , Infecciones por Chlamydia/diagnóstico , Monitoreo de Drogas/métodos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Femenino , Humanos , Infertilidad/diagnóstico , Masculino , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Excreción Vaginal/microbiologíaRESUMEN
This second best practice review examines five series of common primary care questions in laboratory medicine: (1) laboratory testing for allergy, (2) diagnosis and monitoring of menopause, (3) the use of urine cytology, (4) the usefulness of the erythrocyte sedimentation rate, and (5) the investigation of possible urinary tract infection. The review is presented in a question-answer format. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents, and evidence based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are standards but form a guide to be set in the clinical context. Most are consensus rather than evidence based. They will be updated periodically to take account of new information.
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Patología Clínica/métodos , Atención Primaria de Salud/métodos , Sedimentación Sanguínea , Medicina Basada en la Evidencia , Femenino , Humanos , Hipersensibilidad/diagnóstico , Menopausia , Selección de Paciente , Urinálisis , Infecciones Urinarias/diagnósticoRESUMEN
A self-administered questionnaire was used to determine care home staff's reported knowledge of the urinary catheter care standards published by the National Institute for Clinical Excellence (NICE) and the Association of Continence Care, and to see whether this differed in homes with higher catheterization rates. Seven hundred and fifty out of 1438 (52%) nursing and care staff from 37 randomly selected care homes with high, medium and low catheterization rates responded. There was no difference in reported practice in care homes in the three health districts sampled or those with differing catheterization rates. Eighty-three percent of the nursing staff and 40% of the other care staff received formal catheter care training. However, at least 10% of all staff reported not washing their hands before handling a catheter, and delaying emptying a urine bag until it was full, rather than three-quarters full. Only 45% of nursing staff and 40% of other care staff encouraged residents to empty their own catheter bags. Routine use of catheter maintenance solutions or bladder washouts was reported by 50% of all staff. Nursing staff (29%) and other care staff (54%) took urine specimens from the catheter bag tap. Compliance with standards has improved greatly since an audit in 1998. However, some non-compliance remains. There is a need for ongoing local audit and formal training in urinary catheter care, particularly for non-qualified care staff. Education is needed to ensure local implementation of NICE guidance.
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Hogares para Ancianos , Auditoría Médica , Casas de Salud , Encuestas y Cuestionarios , Cateterismo Urinario/normas , Anciano , Enfermería Geriátrica , Adhesión a Directriz , Humanos , Personal de Enfermería/educación , Personal de Enfermería/normas , Calidad de la Atención de Salud , Cateterismo Urinario/instrumentación , Cateterismo Urinario/métodosRESUMEN
This first best practice review examines four series of common primary care questions in laboratory medicine, namely: (i) measurement and monitoring of cholesterol and of liver and muscle enzymes in patients in the context of lipid lowering drugs, (ii) diagnosis and monitoring of vitamin B12/folate deficiency, (iii) investigation and monitoring of paraprotein bands in blood, and (iv) management of Helicobacter pylori infection. The review is presented in a question-answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents, and evidence based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence based. They will be updated periodically to take account of new information.