BOOK
BMJ Clinical Review: Infectious diseases and public health
Doctor Babita Jyoti | Mr Ahmed Hamad
(2016)
Additional Information
Book Details
Abstract
Communicating risk Investigating and managing pyrexia of unknown origin in adults Outpatient parenteral antimicrobial therapy Meticillin resistant Staphylococcus aureus in the hospital Prevention and medical management of Clostridium difficile infection Preparing young travellers for low resource destinations Investigation and treatment of imported malaria in non-endemic countries Diagnosis and management of dengue Diagnosis and management of cellulitis HIV testing and management of newly diagnosed HIV HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity Ebola virus disease Multidrug resistant tuberculosis Actinomycosis Cryptosporidiosis The prevention and management of rabies Diagnosis and management of schistosomiasis Diagnosis, treatment, and management of echinococcosis Manifestation, diagnosis, and management of foodborne trematodiasis Strongyloides stercoralis infection Management of adolescents and adults with febrile illness in resource limited areas Tick bite prevention and tick removal Bed bug infestation The risks of radiation exposure related to diagnostic imaging and how to minimise them,
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Book Cover | C | ||
| Title | i | ||
| Copyright | ii | ||
| About the publisher | iii | ||
| About The BMJ | iii | ||
| Contents | iv | ||
| About the editors | vi | ||
| Introduction to Infectious Diseases and Public Health | vii | ||
| Investigating and managing pyrexia of unknown origin in adults | 1 | ||
| Sources and selection criteria | 1 | ||
| How common is pyrexia of unknown origin? | 1 | ||
| What causes pyrexia of unknown origin? | 1 | ||
| How is pyrexia of unknown origin investigated? | 1 | ||
| Initial approach | 1 | ||
| History | 1 | ||
| Documenting fever | 2 | ||
| Careful physical examination | 2 | ||
| Basic investigations | 2 | ||
| Further investigations | 2 | ||
| What is a reasonable approach to management of pyrexia of unknown origin? | 4 | ||
| Outpatient parenteral antimicrobial therapy | 6 | ||
| What is OPAT? | 6 | ||
| What type of infections can be treated? | 6 | ||
| Cellulitis | 6 | ||
| Bone and joint infections | 6 | ||
| Infective endocarditis | 6 | ||
| Other uses | 6 | ||
| Which patients are suitable? | 6 | ||
| How is OPAT delivered? | 7 | ||
| What are the benefits? | 7 | ||
| What are the risks? | 7 | ||
| How can the risks be reduced? | 8 | ||
| What is the future of OPAT in the UK? | 8 | ||
| Meticillin resistant Staphylococcus aureus in the hospital | 10 | ||
| What is MRSA and why has it become a problem? | 10 | ||
| New strains | 10 | ||
| Mortality, morbidity, and healthcare costs | 10 | ||
| Who gets MRSA infection (table 1 )? | 10 | ||
| How can we detect MRSA? | 11 | ||
| How can we control MRSA? | 11 | ||
| Search and destroy | 11 | ||
| Transmission based precautions | 11 | ||
| Restrictive use of antibiotics | 12 | ||
| How should we treat MRSA infections (table 2 )? | 13 | ||
| In the community | 13 | ||
| In the hospital | 13 | ||
| Prevention and medical management of Clostridium difficile infection | 15 | ||
| Who becomes infected with C difficile ? | 15 | ||
| How does C difficile infection present and how is it diagnosed? | 15 | ||
| How can it be prevented? | 15 | ||
| How can antibiotic stewardship help prevent C difficile infection? | 15 | ||
| What infection control measures should be instituted? | 16 | ||
| Are there any other ways of preventing C difficile infection? | 16 | ||
| How is C difficile managed medically? | 16 | ||
| Which antibiotics are used to treat C difficile infection? | 17 | ||
| What is the appropriate choice for initial antibiotic treatment? | 17 | ||
| What if the patient fails to respond to initial treatment? | 17 | ||
| Are there any other treatment options for refractory disease? | 18 | ||
| How is recurrent C difficile infection diagnosed? | 18 | ||
| How do recommendations differ for recurrent disease? | 18 | ||
| Conclusions | 19 | ||
| Preparing young travellers for low resource destinations | 21 | ||
| What is involved in a pre-travel risk assessment? | 21 | ||
| How can infectious diseases be prevented? | 21 | ||
| What vaccinations need to be considered? | 21 | ||
| How can malaria be prevented? | 21 | ||
| How can diarrhoea be prevented and treated? | 22 | ||
| What should we advise young travellers about personal safety? | 23 | ||
| How can accidents and injuries be prevented? | 23 | ||
| How can violence and attacks by criminals or terrorists be prevented? | 23 | ||
| How can environment related illness be avoided? | 23 | ||
| What should we advise on alcohol and illicit drugs? | 24 | ||
| What should we advise on sexual health? | 24 | ||
| What extra advice should we give medical students and volunteers travelling to developing countries? | 24 | ||
| What about people with a long term medical condition? | 24 | ||
| How can we encourage young travellers to be more responsible for travel health problems? | 24 | ||
| Investigation and treatment of imported malaria in non-endemic countries | 26 | ||
| What is malaria? | 26 | ||
| Who is at risk of acquiring and dying from malaria? | 26 | ||
| How to recognise malaria in adults | 26 | ||
| How is malaria diagnosed? | 27 | ||
| What are the indicators of severe or complicated disease in adults? | 27 | ||
| What are the indicators of severe or complicated disease in children? | 27 | ||
| What about malaria in pregnancy? | 27 | ||
| How is uncomplicated non-falciparum malaria managed? | 28 | ||
| How should uncomplicated falciparum malaria be managed? | 28 | ||
| Is malaria resistance increasing? | 28 | ||
| How should severe and potentially complicated malaria be managed? | 29 | ||
| What is the prognosis after malaria? | 29 | ||
| Dengue fever | 31 | ||
| Who gets dengue fever? | 31 | ||
| What causes dengue fever? | 31 | ||
| Can dengue fever be prevented? | 31 | ||
| Primary prevention | 31 | ||
| Screening | 32 | ||
| Secondary prevention | 32 | ||
| How is dengue fever diagnosed? | 32 | ||
| History | 32 | ||
| Physical examination | 32 | ||
| Phases of infection | 33 | ||
| Laboratory investigations | 33 | ||
| Initial laboratory investigations | 33 | ||
| Confirmatory laboratory investigations | 33 | ||
| Imaging | 33 | ||
| How is dengue fever managed? | 34 | ||
| Treatment approach | 34 | ||
| Severity of infection | 34 | ||
| Group A | 34 | ||
| Group B | 34 | ||
| Group C | 34 | ||
| Management of group C patients | 34 | ||
| Management of group B patients | 34 | ||
| Management of group A patients | 35 | ||
| Pregnancy | 35 | ||
| Children | 36 | ||
| Convalescence and discharge | 36 | ||
| Adjunctive therapies | 36 | ||
| Disease notification | 36 | ||
| What are the complications of dengue fever? | 36 | ||
| Prognosis | 36 | ||
| Long term sequelae | 36 | ||
| Recurrence | 36 | ||
| Monitoring | 36 | ||
| Patient instructions | 36 | ||
| Are there any emerging treatments? | 36 | ||
| Corticosteroids | 36 | ||
| Antiviral drugs | 36 | ||
| Vaccines | 36 | ||
| Diagnosis and management of cellulitis | 38 | ||
| What is the extent of the problem? | 38 | ||
| What causes cellulitis? | 38 | ||
| Who is at risk of cellulitis? | 38 | ||
| Can cellulitis be prevented in those at risk? | 38 | ||
| How is the diagnosis of cellulitis made? | 38 | ||
| Clinical diagnosis | 38 | ||
| Blood investigations | 38 | ||
| Microbiology | 39 | ||
| Imaging | 39 | ||
| What is the treatment of cellulitis? | 40 | ||
| When should a person be admitted to hospital for intravenous antibiotics? | 40 | ||
| Eron classification v Dundee classification | 40 | ||
| Outpatient parenteral antibiotic therapy (OPAT) | 40 | ||
| When should a switch to oral antibiotics be made? | 41 | ||
| When to seek further advice? | 41 | ||
| Can recurrence be prevented? | 41 | ||
| Antibiotic prophylaxis | 41 | ||
| HIV testing and management of newly diagnosed HIV | 43 | ||
| What is the current epidemiology of HIV infection in the UK? | 43 | ||
| Why diagnose the undiagnosed, and why the hurry? | 43 | ||
| Undiagnosed HIV infection | 43 | ||
| Late diagnosis of HIV infection | 43 | ||
| Who should be tested for HIV infection in the UK? | 44 | ||
| What conditions should prompt general practitioners to consider testing for HIV? | 44 | ||
| Testing in primary HIV infection | 45 | ||
| Who can test? | 46 | ||
| Which HIV test should be used? | 46 | ||
| How should patients obtain their results? | 46 | ||
| Ensuring safe governance of results | 47 | ||
| Ensuring appropriate transfer to care, and collaborative working with specialist services | 47 | ||
| How often should a patient be offered an HIV test? | 47 | ||
| Management of patients with newly diagnosed HIV | 47 | ||
| How do I deal with a “reactive” HIV test result? | 47 | ||
| Patients with reactive HIV screening test results: how do I know if this is a true positive result? | 47 | ||
| What is the best way to deliver a positive test result? | 47 | ||
| What happens at a first consultation with an HIV specialist? | 47 | ||
| The medical history | 47 | ||
| Physical examination | 48 | ||
| Baseline investigations | 48 | ||
| Interventions in the initial assessment | 48 | ||
| Partner notification | 48 | ||
| Immunisation | 48 | ||
| How can patients be encouraged to disclose their HIV status to other healthcare professionals? | 48 | ||
| When will my patient start antiretroviral therapy? | 49 | ||
| HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity | 51 | ||
| Untreated HIV infection increases the risk of non-AIDS related events | 51 | ||
| Can antiretroviral treatment fully restore health in most patients? | 51 | ||
| Low CD4+ T cell counts during treatment predict non-AIDS events | 51 | ||
| How effective is antiretroviral therapy in restoring normal CD4+ T cell counts? | 51 | ||
| Which non-AIDS related diseases are affected? | 52 | ||
| Cardiovascular disease | 52 | ||
| Cancer | 52 | ||
| Liver and renal disease | 52 | ||
| Other diseases | 53 | ||
| Immunological ageing | 53 | ||
| Why are treated patients still at risk for premature morbidity and mortality? | 53 | ||
| What are the clinical implications? | 53 | ||
| Conclusion | 54 | ||
| Ebola virus disease | 55 | ||
| What causes it? | 55 | ||
| What is the pathophysiology of this infection | 55 | ||
| How are people at risk identified? | 56 | ||
| Contacts | 56 | ||
| What infection prevention and control measures are used? | 56 | ||
| Personal protective equipment | 57 | ||
| What other measures are needed if Ebola virus disease is suspected? | 57 | ||
| What are the clinical features? | 57 | ||
| History | 58 | ||
| Symptoms | 58 | ||
| Physical examination | 58 | ||
| How is it investigated? | 59 | ||
| Initial investigations | 59 | ||
| Other investigations | 60 | ||
| How is it managed? | 60 | ||
| Isolation and infection control | 60 | ||
| Fluid and electrolyte replacement | 61 | ||
| Symptomatic management | 61 | ||
| Are there any emerging treatments? | 61 | ||
| Convalescent whole blood or plasma | 61 | ||
| ZMapp | 61 | ||
| TKM-Ebola | 61 | ||
| Brincidofovir | 62 | ||
| Favipiravir | 62 | ||
| BCX-4430 | 62 | ||
| AVI-7537 | 62 | ||
| Other agents | 62 | ||
| Vaccines | 62 | ||
| What is the prognosis? | 62 | ||
| Infection course | 62 | ||
| Recovery and convalescence | 62 | ||
| What advice should patients be given during recovery? | 62 | ||
| Related links | 64 | ||
| Infectious mononucleosis | 65 | ||
| What is infectious mononucleosis and what causes it? | 65 | ||
| How is it diagnosed? | 65 | ||
| How is it treated? | 67 | ||
| Are steroids of use in the treatment of infectious mononucleosis? | 67 | ||
| Does infectious mononucleosis lead to chronic fatigue syndrome? | 67 | ||
| When is it safe to return to sports? | 68 | ||
| Is multiple sclerosis caused by infectious mononucleosis? | 68 | ||
| Is there an increased risk of lymphoma or other cancers after infectious mononucleosis? | 69 | ||
| Can infectious mononucleosis cause any complications? | 69 | ||
| Multidrug resistant tuberculosis | 70 | ||
| What is multidrug resistant tuberculosis? | 70 | ||
| How common is it? | 70 | ||
| What is the prognosis? | 70 | ||
| Who is at risk of multidrug resistant tuberculosis? | 70 | ||
| How is it diagnosed? | 71 | ||
| Phenotypic indirect drug susceptibility testing | 71 | ||
| Phenotypic direct drug susceptibility testing | 71 | ||
| Genotypic drug susceptibility testing | 71 | ||
| How is it treated? | 72 | ||
| Recommended drug regimens | 72 | ||
| Challenges to management | 72 | ||
| Emerging treatments | 72 | ||
| What is the role of palliative care? | 73 | ||
| What are the public health implications? | 73 | ||
| What are the future directions? | 73 | ||
| Actinomycosis | 75 | ||
| How is actinomycosis acquired? | 75 | ||
| How common is it and who gets it? | 75 | ||
| How does it present? | 75 | ||
| How is actinomycosis diagnosed? | 76 | ||
| Blood tests | 76 | ||
| Imaging | 76 | ||
| Histopathology | 76 | ||
| Microbiology | 77 | ||
| How is actinomycosis managed? | 78 | ||
| Which antibiotics can be used to treat actinomycosis? | 78 | ||
| What are the appropriate choices for initial antibiotic treatment? | 78 | ||
| When should surgery be considered? | 78 | ||
| What is the optimal duration of treatment? | 78 | ||
| What is the treatment for immunocompromised patients? | 79 | ||
| What should happen to IUDs in pelvic or abdominal actinomycosis? | 79 | ||
| What is the prognosis of actinomycosis? | 79 | ||
| Cryptosporidiosis | 81 | ||
| Sources and selection criteria | 81 | ||
| Who gets cryptosporidiosis? | 81 | ||
| How is cryptosporidiosis acquired? | 81 | ||
| What are the clinical features of cryptosporidiosis? | 81 | ||
| What are the long term effects of infection? | 82 | ||
| How is infection with Cryptosporidium diagnosed? | 82 | ||
| How is cryptosporidiosis managed? | 83 | ||
| Immunocompetent patients | 83 | ||
| Immunocompromised patients | 83 | ||
| Immune reconstitution | 83 | ||
| Specific therapy | 83 | ||
| What else is known about the epidemiology of cryptosporidiosis? | 84 | ||
| The prevention and management of rabies | 86 | ||
| What is the global burden of rabies? | 86 | ||
| What are the trends in global rabies control and elimination? | 86 | ||
| Who is at risk? | 86 | ||
| How is rabies transmitted? | 87 | ||
| Can it be prevented? | 87 | ||
| Pre-exposure vaccination | 87 | ||
| Routes for administering vaccines | 87 | ||
| What measures should be taken after a possible rabies exposure (such as dog bite)? | 88 | ||
| Step 1: wound care | 88 | ||
| Step 2: vaccination | 88 | ||
| Step 3: rabies immunoglobulin | 89 | ||
| What are the symptoms of rabies? | 89 | ||
| Are any treatments available for rabies? | 90 | ||
| Are any new treatment or prevention strategies on the horizon? | 90 | ||
| What is the advice for travelers to rabies endemic countries? | 90 | ||
| Diagnosis and management of schistosomiasis | 92 | ||
| Where and how is schistosomiasis acquired? | 92 | ||
| What are the clinical features of schistosomiasis? | 92 | ||
| Early manifestations | 92 | ||
| Rash | 92 | ||
| Acute schistosomiasis (Katayama syndrome) | 92 | ||
| Chronic and advanced disease | 93 | ||
| Gastrointestinal and liver disease | 93 | ||
| Genitourinary disease | 93 | ||
| Additional morbidity associated with schistosomiasis | 93 | ||
| How is schistosomiasis diagnosed? | 95 | ||
| How is schistosomiasis treated? | 97 | ||
| Praziquantel | 97 | ||
| Adjuvant treatment | 97 | ||
| Other antiparasitic agents | 97 | ||
| What are the future challenges? | 98 | ||
| Diagnosis, treatment, and management of echinococcosis | 100 | ||
| Where and how is echinococcosis acquired? | 100 | ||
| What are the clinical features of echinococcosis? | 100 | ||
| How is echinococcosis diagnosed? | 100 | ||
| How is CE treated and managed? | 102 | ||
| Surgery | 102 | ||
| Percutaneous sterilisation techniques | 103 | ||
| Antiparasite drug treatment | 103 | ||
| Watch and wait | 103 | ||
| How is AE treated and managed? | 103 | ||
| What are the future challenges? | 104 | ||
| Management of chronic hepatitis B infection | 107 | ||
| Introduction | 107 | ||
| Incidence and prevalence | 107 | ||
| Sources and selection criteria | 107 | ||
| Diagnosis and initial evaluation | 107 | ||
| Phases of HBV infection | 108 | ||
| HBeAg negative chronic HBV | 108 | ||
| Occult HBV infection | 108 | ||
| Assessment of liver fibrosis | 108 | ||
| Serologic biomarkers | 108 | ||
| Transient elastography | 109 | ||
| Treatment initiation | 109 | ||
| People with cirrhosis | 109 | ||
| People without cirrhosis | 109 | ||
| People in the inactive carrier state | 109 | ||
| Other patients | 109 | ||
| Predictors of treatment outcome | 110 | ||
| Currently available treatments | 110 | ||
| Pegylated interferon | 110 | ||
| Nucleos(t)ide analogs | 111 | ||
| Entecavir | 111 | ||
| Tenofovir disoproxil fumarate | 111 | ||
| Antiviral resistance | 112 | ||
| Monitoring surface antigen level | 112 | ||
| Treatment withdrawal | 112 | ||
| HBeAg positive patients | 112 | ||
| HBeAg negative patients | 112 | ||
| Outcomes of HBV treatment | 112 | ||
| HIV coinfection | 113 | ||
| Hepatitis delta | 113 | ||
| Pregnancy | 113 | ||
| HBV reactivation after immunosuppression | 114 | ||
| HBsAg positive patients | 114 | ||
| HBsAg negative, anti-HBc positive patients | 114 | ||
| Emerging treatments | 115 | ||
| Conclusion | 115 | ||
| Guidelines | 115 | ||
| The role of pathogen genomics in assessing disease transmission | 119 | ||
| Introduction | 119 | ||
| Sources and selection criteria | 119 | ||
| How has clinical medicine benefited from pathogen genomics? | 120 | ||
| Old and new definitions of pathogen diversity | 120 | ||
| Genomic differences in pathogen virulence and transmissibility | 120 | ||
| Investigating the origin and spread of high impact pathogens | 120 | ||
| New insights into disease spread and transmission provided by genome sequencing | 121 | ||
| Cross species transmission and host adaptation | 121 | ||
| Intra-host and inter-host pathogen evolution and transmission | 121 | ||
| Non-invasive bacterial disease and colonisation as enablers of transmission | 122 | ||
| Intra-host heterogeneity and modes of transmission | 122 | ||
| Case study: the evolution and transmission pathways of hospital acquired MRSA | 122 | ||
| Analysis of the spread of pathogens at different scales | 123 | ||
| Real time outbreak analysis | 123 | ||
| Analysis of person to person transmission networks | 124 | ||
| Summary | 124 | ||
| Clinical applications of developments in pathogen genomics | 124 | ||
| Active high resolution public health laboratory surveillance | 124 | ||
| Proactive disease control guided by the identification of transmission pathways | 125 | ||
| Genomics enhanced clinical risk assessment | 125 | ||
| Pathogen genome sequencing | 126 | ||
| The challenges of data analysis and integration | 126 | ||
| Conclusion | 127 | ||
| Manifestation, diagnosis, and management of foodborne trematodiasis | 130 | ||
| What causes foodborne trematodiasis? | 130 | ||
| Where does foodborne trematodiasis occur? | 130 | ||
| What are the pathological consequences and clinical manifestations? | 131 | ||
| Clonorchiasis and opisthorchiasis | 131 | ||
| Fascioliasis | 132 | ||
| Paragonimiasis | 133 | ||
| Intestinal fluke infection | 133 | ||
| What are the other complications of foodborne trematodiasis? | 133 | ||
| How can foodborne trematodiasis be diagnosed? | 133 | ||
| How can foodborne trematodiasis be treated? | 134 | ||
| Towards control and elimination: challenges and opportunities | 135 | ||
| Strongyloides stercoralis infection | 137 | ||
| What is the lifecycle of strongyloides? | 137 | ||
| Who gets strongyloidiasis? | 137 | ||
| What are the symptoms of strongyloidiasis? | 137 | ||
| How is strongyloidiasis diagnosed? | 138 | ||
| When should patients with strongyloidiasis be referred? | 138 | ||
| What is strongyloides hyperinfection syndrome? | 138 | ||
| How is strongyloidiasis treated? | 139 | ||
| How is strongyloides hyperinfection syndrome treated? | 140 | ||
| How is treatment efficacy assessed? | 140 | ||
| Management of adolescents and adults with febrile illness in resource limited areas | 142 | ||
| How should febrile adults be managed at the first level health facility? | 142 | ||
| Rapid triage and emergency management | 142 | ||
| Assessment, classification, and management of acute illness | 142 | ||
| Quality of evidence | 143 | ||
| What are the challenges for clinicians at the district hospital level? | 144 | ||
| Inadequate facilities for diagnosis | 144 | ||
| Few point of care tests | 144 | ||
| Barriers to changing clinicians’ behaviour | 145 | ||
| Why is ruling out malaria important? | 145 | ||
| Is it strictly necessary to diagnose HIV infection? | 145 | ||
| Why is it important to know the local causes of fever? | 145 | ||
| Limitations of empirical treatment | 145 | ||
| Limited diagnostic testing | 145 | ||
| How can local epidemiological data be acquired? | 145 | ||
| Local and national surveillance | 145 | ||
| Sentinel hospital studies | 146 | ||
| Future directions | 146 | ||
| Tick bite prevention and tick removal | 148 | ||
| What is a tick? | 148 | ||
| What diseases are spread by ticks? | 148 | ||
| How can tick bites be prevented? | 148 | ||
| Which repellents are effective against ticks? | 148 | ||
| Trans -p-methane-3,8-diol (PMD) | 148 | ||
| N,N-diethyl-3-methylbenzamide and other synthetic repellents | 149 | ||
| Does protective clothing prevent tick bites? | 149 | ||
| How effective is permethrin or DEET impregnated clothing? | 149 | ||
| How do ticks attach and why is removal important? | 150 | ||
| How quickly should a tick be removed? | 150 | ||
| Which methods of removal don’t work? | 150 | ||
| How should a tick be removed correctly? | 150 | ||
| What to do after a tick bite? | 150 | ||
| Bed bug infestation | 153 | ||
| What are bed bugs? | 153 | ||
| Where are bed bugs found? | 153 | ||
| How common are bed bug infestations? | 153 | ||
| What are the symptoms of bed bug infestation? | 153 | ||
| What are the differential diagnoses of bed bug bites? | 154 | ||
| What complications can arise from bed bug infestations? | 154 | ||
| How are bed bug infestations managed? | 154 | ||
| How should bed bug bites be treated? | 155 | ||
| How can bed bugs be identified and eradicated? | 155 | ||
| Patient education | 155 | ||
| Non-chemical intervention | 155 | ||
| Chemical treatment | 155 | ||
| How can infestation be prevented? | 156 | ||
| Management of sharps injuries in the healthcare setting | 158 | ||
| What is a sharps injury? | 158 | ||
| Where do sharps injuries occur? | 158 | ||
| What are the risks associated with sharps injuries? | 158 | ||
| What should be done immediately after a sharps injury? | 158 | ||
| How is a risk assessment performed? | 158 | ||
| What blood tests are required for source patients and recipients? | 159 | ||
| What consent is required? | 159 | ||
| When should post-exposure prophylaxis for HIV be started? | 159 | ||
| How can the transmission of hepatitis B virus be prevented? | 160 | ||
| What can be done about exposure to hepatitis C virus? | 160 | ||
| How is care accessed in different healthcare settings? | 161 | ||
| How should injured healthcare workers be followed up? | 161 | ||
| The risks of radiation exposure related to diagnostic imaging and how to minimise them | 163 | ||
| Why is exposure to radiation from medical imaging increasing? | 163 | ||
| What levels of radiation accompany routinely performed procedures? | 163 | ||
| How much radiation exposure is usual? | 163 | ||
| What are the known consequences of radiation exposure? | 164 | ||
| Cancer | 164 | ||
| Non-neoplastic effects | 164 | ||
| Understanding the size of increased risks | 164 | ||
| Who is most at risk? | 164 | ||
| Pregnant women | 164 | ||
| Children | 165 | ||
| How to reduce the risk? | 165 | ||
| Calculate before you order | 165 | ||
| Reduce unnecessary computed tomography examinations | 165 | ||
| Use other imaging techniques if possible | 165 | ||
| Standardise operating procedures for radiological examinations | 165 | ||
| Use technological advances to increase safety | 165 | ||
| What should patients be told? | 165 | ||
| Conclusion | 166 | ||
| Facemasks for the prevention of infection in healthcare and community settings | 167 | ||
| Introduction | 167 | ||
| Sources and selection criteria | 167 | ||
| Use of facemasks and respirators in healthcare settings | 168 | ||
| Efficacy of facemasks and respirators in healthcare settings | 168 | ||
| Randomised controlled trials | 168 | ||
| Bacterial colonisation | 169 | ||
| Non-randomised studies | 169 | ||
| Role of cloth masks | 169 | ||
| Facemasks as source control | 169 | ||
| The use of facemasks in the community setting | 169 | ||
| Efficacy of facemasks in the community | 170 | ||
| Community use of facemasks during outbreaks and pandemics | 171 | ||
| Choice of facemask versus respirator | 171 | ||
| Transmission modes | 172 | ||
| High risk situations | 172 | ||
| Organisational and individual factors | 172 | ||
| Regulations, training, and fit testing of respirators | 173 | ||
| Policies and guidelines around the use of facemasks and respirators | 173 | ||
| Research gaps | 174 | ||
| Limitations of existing evidence | 174 | ||
| New research | 174 | ||
| Conclusion | 174 | ||
| Communicating risk | 178 | ||
| What is risk communication? | 178 | ||
| Why is risk communication important? | 178 | ||
| How good (or bad) are clinicians at communicating risk? | 178 | ||
| Barriers to effective risk communication | 179 | ||
| Methods available to communicate risk | 179 | ||
| Framing | 179 | ||
| Presenting risk reduction | 179 | ||
| Personalising risk information | 179 | ||
| Natural frequencies | 180 | ||
| Decision aids | 180 | ||
| Uncertainty | 181 | ||
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