New directions in the diagnosis and therapy of urinary tract infections

Article Abstract:

Urinary tract infections (UTIs) are very common in women, and should be grouped into complicated and uncomplicated categories to determine the most appropriate and cost-effective treatments. Classification is based on history, symptoms, risk factors, and physical examination. Complicated UTIs are associated with a history of recurrent infections, signs or symptoms of upper tract disease, or co-existing conditions such as pregnancy. Uncomplicated UTIs are characterized by symptoms of lower tract infection of short duration, and the absence of fever and flank pain (toward the side of the lower back area). Symptoms of UTI include pain during urination, increased frequency and urgency of urination, blood in the urine, and pain above the pubic arch (where the two pelvic bones meet in the lower abdomen). Escherichia coli, other Enterobacteriaceae, Staphylococcus saprophyticus, and Enterococcus cause 90 percent of uncomplicated UTIs. Diagnosis of UTI is based on information from the patient's medical history, a brief physical examination, and urinalysis. UTI is suspected when the urine contains pus, blood, or bacteria. Urine cultures, or attempts to grow microorganisms from urine specimens, are expensive and unnecessary in uncomplicated UTI. Pain during urination may also be caused by inflammation of the vagina, lesions in the genital area, physical or chemical irritants, and sexually transmitted diseases. The success of therapy depends on the appropriate selection of a drug and the duration of treatment. There are various types of antibacterial agents and various ways of prescribing them. Three days of antibiotic treatment was shown to be effective in eliminating uncomplicated UTI and reducing recurrent infection. Recurrence may result from infection of the upper urinary tract. The drugs of choice for treating UTI include penicillins, sulfas, and quinolone antibiotics. The decision of which antimicrobial to use is based on cost, allergy, side effects, and the range of bacteria against which the drug is active. Information about the sensitivity of infecting bacteria to specific antibiotics and patient tolerance to a drug under consideration help to determine the appropriate treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Antibiotics, Drug therapy, Urinary tract infections, Cystitis

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Establishing an NP-staffed minor emergency area

Article Abstract:

Suggested ways to run a minor emergency area (MEA) by nurse practitioners (NPs) have been described. A number of less complicated conditions can be seen by NPs in a self-contained area of the hospital called the MEA. The structure of an MEA may vary by state according to the laws governing NPs' rights to dispense medication, be reimbursed by third party payers, and their extent of independence. Research has shown that patients have been treated appropriately in MEAs.

Emergency medical services, Emergency medical personnel

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Nurse-managed primary care

Article Abstract:

The overall structure of an award-winning health center staffed and run by nurse practitioners (NPs) has been presented. The center's staff researched the health needs of their immediate community and developed a tailored health care program as well as providing for individual needs. Costs to a contracted health maintenance organization from this center were lower than traditional family services and patients were seen more often.

Community health services

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