Chlamydial infections

Chlamydia causes many human infections and should be treated aggressively. Tetracycline or doxycycline are the drugs of choice, but erythromycin can be used if a drug allergy is present or if tetracyclines are contraindicated. In the pregnant woman, aggressive treatment can improve neonatal outcome. In the United States, each year 155,000 infants are exposed to Chlamydia trachomatis during the birth process, and more than 100,000 will be infected. Of these, 75,000 will get conjunctivitis, and 30,000 will get pneumonia. In pregnancy, erythromycin is the drug of choice, with treatment recommended after initial culture and at term if repeat cultures are positive. If erythromycin is not tolerated, or the patient has an allergy to it, ampicillin or clindamycin may be effective alternatives.     

Chlamydial infections

Chlamydia trachomatis is a unique intracellular parasite that causes a number of common sexually transmitted disease syndromes, including nongonococcal urethritis in both men and women, epididymitis in men, and pelvic inflammatory disease in women. Infants exposed at delivery are at risk for the development of conjunctivitis and pneumonia. There is strong evidence that Chlamydia is a cause of obstructive infertility and ectopic pregnancy in women. It appears that these complications result from the chronic inflammatory response and secondary scarring that are elicited by long-term asymptomatic or nearly asymptomatic fallopian tube infections. Because treatment with tetracycline, doxycycline, or erythromycin is simple, effective, and inexpensive, major efforts should be put into identifying asymptomatic young women through screening of the subpopulations at highest risk. These include sexually active adolescent women and older women who are not monogamous. Blacks are at higher risk than other ethnic groups for infection. The cost of diagnosing chlamydial infection has decreased with the introduction of new nonculture diagnostic tests. This should increase the availability of testing for screening purposes. It is critical to remember that male sex partners of infected women must be treated; otherwise all efforts to prevent long-term complications by identifying and treating asymptomatic women are doomed to failure.     

Osteoporosis: a growing epidemic.

The osteoporosis epidemic will continue unabated unless the issue of prevention of bone loss is seriously addressed. While a continuing programme of education for both the medical profession and the general public is necessary, positive action is required. Women lose bone at an accelerated rate following the menopause and this seems to be the optimal time for intervention. Those women who enter the menopause with the lowest bone density are at greatest risk of subsequent fracture. An individual's bone density can be accurately measured and those women who have the lowest bone density should have hormone replacement therapy (HRT) recommended, but it is important to discuss fully the possible benefits and risks. It is probable that non-hormonal agents for prevention of bone loss will be available in the near future, and cyclical diphosphonate therapy appears particularly promising. However, at the present time, long-term HRT is the mainstay for the prevention of bone loss.     

AIDS: legal issues in a growing epidemic

The article reviews selected legal issues regarding AIDS and HIV infection. Following an overview of the legislative and regulatory structure of public health laws in the United States, the article describes legal issues relating to the development of an AIDS vaccine, determination of appropriate professional liability standards in diagnosing and treating persons with AIDS or HIV infection, availability of tort law damages for persons negligently or intentionally exposed to infection, use of criminal laws against individuals who engage in conduct likely to transmit the virus, and protections against discrimination available to individuals with AIDS or HIV infection.     

Incidence and nature of epidemic nosocomial infections.

Nosocomial bloodstream infections continue to be a major cause of morbidity and mortality. Approximately 8% of all nosocomial infections reported in the United States are primarily bloodstream infections. These infections prolong hospital length of stay, increase mortality, and raise the overall cost of healthcare. A contaminated infusate administered through a central venous catheter is one of the commonly identified causes of nosocomial bacteremia. In most cases, contamination of the infusate occurs extrinsically during manipulation of the fluid before its administration to the patient. Failure to use aseptic technique and poor hand washing often are the cause. In addition to improved staff education, surveillance for nosocomial bloodstream infections continues to be the cornerstone of prevention.     

Sexually transmitted diseases: perspectives on this growing epidemic.

Despite advances with antibiotic therapies and increased public attention to acquired immunodeficiency syndrome, sexually transmitted diseases remain a major public health problem of epidemic proportions in the United States. The emergence of new pathogens and clinical syndromes has increased the complexity of the situation. Incurable conditions and asymptomatic disease states during an era of constrained public resources and deficient public awareness further heighten and compound the devastating consequences of sexually transmitted disease. The provision of comprehensive disease prevention, education and clinical services is an important and complicated dimension. Sexually transmitted diseases are responsible for considerable morbidity and substantial mortality, particularly among young women. This article provides an overview of the epidemic in financial and human terms, with a discussion of eight major pathogens from an epidemiological, clinical and educational-counseling perspective.     

The 'other' sexually transmitted diseases. Chlamydial, herpes simplex virus, and human papillomavirus infections.

The incidence of sexually transmitted diseases continues to rise across the country. Because many cases are subclinical and asymptomatic, chlamydial, herpes simplex virus, and human papillomavirus (HPV) infections continue to spread at an alarming rate. These infections can lead to serious sequelae, such as pelvic inflammatory disease, infertility, and cervical dysplasia or carcinoma, so improved disease-control strategies are needed. Preventive efforts should include use of the latest diagnostic and therapeutic methods to uncover and eradicate subclinical chlamydial and HPV infections. In addition, notification of sexual partners should be encouraged. Education about prevention of sexually transmitted diseases should be incorporated into basic primary medical care for all sexually active patients.     

Gaining control of the CNS role through written contracts

Maintaining control of the many aspects of the clinical nurse specialist (CNS) role can be frustrating at times. This article describes the strategy of contract writing to regain control. The following 10 advantages of the method are described. The contract orients staff to the CNS role, formalizes the goal setting process, strengthens relationships, establishes time commitments, serves as a basis for ongoing contracts, sets an evaluation date, furnishes a written record, is a tool for time management, provides a method for conflict management, and provides a mechanism for mutual gain. Examples of a contract and action plan are included.