Evaluating the use of penicillin to control outbreaks of acute poststreptococcal glomerulonephritis.

INTRODUCTION: Outbreaks of acute poststreptococcal glomerulonephritis (APSGN), occur every few years in remote Australian Aboriginal communities. Intervention with benzathine penicillin G (BPG) to all children is effective in reducing streptococcal carriage in a community, but its effectiveness in arresting outbreaks of APSGN has not been established. OBJECTIVE: To study nine recent community outbreaks of APSGN in Australia's Northern Territory and compare them with outbreaks reported in the literature to assess the impact of intervention with BPG. METHODS: Because randomized controlled trials have not been conducted for this purpose, we assessed data from published observational studies and relevant experiences in the Northern Territory (NT). Eight of the nine outbreaks in the NT were studied prospectively. An outbreak was defined as two or more clinical cases of APSGN occurring within 1 week in a single community. Three intervention methods were used: intramuscular BPG to all children ages 3 to 15 years; BPG only to children with skin lesions; and BPG only to child contacts of clinical cases. The attack rates, number of clinical cases before and after the interventions were documented and the coverage of children with penicillin were estimated. RESULTS: A review of the literature found very little evidence either for or against the effectiveness of intervention with BPG. In our study four communities used the first method of intervention. The community with the lowest uptake of penicillin continued to have cases in untreated children for 9 further weeks, two communities had no new cases from 3 weeks after the intervention and the fourth had a single further case after 4 weeks. The one community that used the second method had a high initial attack rate but no further cases from 1 week after the intervention. Three communities used the third method and in one community no intervention was attempted. CONCLUSION: Our observational study supports the use of BPG in the community to prevent new cases of APSGN. It suggests that targeted treatment of children with skin sores and household contacts of cases, rather than attempted treatment of all children in the community, could be an effective method of intervention.

A resource kit for women with breast cancer: development and evaluation.

PURPOSE/OBJECTIVES: To describe the development and evaluation of the Resource Kit for Women With Breast Cancer, designed to facilitate adaptation to diagnosis, treatment, and recovery. DATA SOURCES: Distributed to more than 200 women with newly diagnosed breast cancer. Derived from the Roy Adaptation Model of Nursing and the literature. DATA SYNTHESIS: The kit may be helpful, particularly for women who are too overwhelmed by their situations to retain the vast amount of new information to which they are exposed. CONCLUSIONS: The kit has the potential to assist women to adapt physically, emotionally, functionally, and interpersonally by concisely combining numerous relevant resources in one place, thereby facilitating the location and review of specific information. IMPLICATIONS FOR NURSING PRACTICE: The kit is a complete package that can be used independently of any professional support as a guide for women during individualized professional telephone support or as an adjunct to formal breast cancer support groups.

Surgical morbidity in the North Coast Health Region.

A comparison of morbidity following 20 selected surgical procedures was conducted in the North Coast Health Region of NSW in 1988. Morbidity rates between procedures, hospitals and hospital levels were compared and the effects of age, gender and the American Society of Anesthesiologists rating on morbidity were examined. The respective perceptions of doctors and patients regarding complications were also compared. The study gives conditional support to the continuation of a surgical programme in Level 3 hospitals in the North Coast Health Region.