Medical Inspection - Health Blog

Low prevalence of VRE gastrointestinal colonization: RESULTS

Posted in Main | January 9th, 2012

The number of stool specimens evaluated in the first two weeks of each eight week period between January 1 and December 31,1997 ranged from 187 to 265. A total of 1408 stool specimens were tested. Sixty-seven of the 1408 (4.8%) hospitalized patients evaluated had VRE colonization of their lower GIT. Three of the 67 (4.5%) VRE identified were E faecium, while the remaining 64 isolates (95.5%) were Enterococcus gallinarum. Three of 1408 (0.2%) patients hospitalized in Manitoba, who had a stool specimen submitted for C difficile testing during the study period, were colonized with VREF. One isolate of VREF was identified at the Misericordia General Hospital, a Winnipeg community hospital, between April 23 and May 7, 1997. The two remaining isolates of VREF were identified between June 18 and July 2, 1997 at the Health Sciences Centre, a Winnipeg tertiary care hospital.

Low prevalence of VRE gastrointestinal colonization: MATERIALS AND METHODS

Posted in Main | January 8th, 2012

Enterococcus species isolate collection: Seven Winnipeg hospitals (Health Sciences Centre, St Boniface General Hospital, Misericordia General Hospital, Concordia General Hospital, Victoria General Hospital, Grace General Hospital, and Seven Oaks General Hospital) as well as hospitals in the rural Manitoba communities of Brandon, Thompson and Portage la Prairie participated. The Health Sciences Centre and St Boniface General Hospital are tertiary care teaching hospitals affiliated with the University of Manitoba. The remaining eight hospitals are community hospitals.

The study was divided into six, eight-week intervals, and extended from January 1 to December 31,1997. Each hospital collected stool specimens submitted for Clostridium difficile toxin and/or culture testing in the first two weeks of each eight week interval from patients in their hospitals. One stool specimen per patient was considered. Stool specimens were frozen following collection and shipped to one of two central reference laboratories (Health Sciences Centre and the St Boniface General Hospital) where they were thawed and planted onto blood agar (BA), colistin-nalidixic acid agar (CNA), and colistin- nalidixic acid agar supplemented with 6 g/mL vancomycin (CNAV). All plates were incubated at 35°C for 48 h.

Low prevalence of VRE gastrointestinal colonization

Posted in Main | January 7th, 2012

Low prevalence of VRE gastrointestinal colonization of hospitalized patients in Manitoba tertiary care and community hospitals

Vancomycin-resistant Enterococcus faecium (VREF) accounts for up to 65% of Efaecium isolates in hospitalized patients across the United States and is endemic in many North American tertiary care institutions. The management of these infections presents a significant clinical challenge because species of the genus Enterococcus, and in particular Efaecium, are frequently resistant to several antimicrobial agents. High level penicillin resistance, high level aminoglycoside resistance and most recently vancomy- cin resistance are emerging as significant concerns in the treatment of enterococcal infections. This has prompted the development and evaluation of new antimicrobial agents such as quinupristin/dalfopristin and LY333328, a glycopeptide, which may offer activity against enterococci resistant to conventional therapy.

Complementary and alternative medicine use by patients: DISCUSSION part 2

Posted in Disease | January 6th, 2012

By using the Internet, we were able to recruit a large number of subjects with little effort. The subjects were predominantly from the United States, but a significant proportion were from other countries. The sample was heterogeneous, including a range of disease severity, disease duration and treatments. However, this study was limited by the inherent difficulties in conducting a study on the Internet, which have been discussed elsewhere in terms of IBD research. These difficulties include the inability to sample a defined population or to even determine exactly what population was sampled. Not all people have access to the Internet. In a recent study on the information needs and sources of patients with IBD, 33% reported having access to the Internet, although only 23% had used it to get information about their disease. Those using the Internet are likely more educated and may have a higher socioeconomic status than Internet nonus- ers. Higher education has been associated with CAM use. Because many participants of the Internet sample found the questionnaire through actively seeking IBD- related Internet sites, they are likely characterized by a strong desire for knowledge about their disease, and to be in control of their disease and its management. One might suspect that those who took the time to access the website and complete the questionnaire were those who had the most favourable experiences with and opinions about CAM. However, this may not have been the case because only a third of subjects rated their satisfaction as at least a 4 out of 5, and the clinic subjects overall appeared to be more satisfied with CAM than the Internet subjects.

Soetikno et al, in a study of quality of life of patients with ulcerative colitis following surgery, also found systematic differences between a clinic and an Internet population. However, in contrast to our study, the ulcerative colitis patients recruited through the Internet were more ill than those recruited through the clinic. This difference may be explained by the different focuses of the studies. A study of quality of life might be expected to attract those whose quality of life has been adversely affected by more serious disease, whereas disease activity may not have influenced the likelihood of responding to this survey, although other selection pressures may have occurred.

Complementary and alternative medicine use by patients: DISCUSSION

Posted in Disease | January 5th, 2012

Complementary and alternative medicine use by patients: DISCUSSION

In keeping with other single-centre studies, we have shown that the use of CAM by patients with IBD is common. The proportions of patients who had used or were currently using CAM were very similar to the proportions found in our earlier study of IBD patients in Calgary. Also in keeping with our previous study was the common use of multiple different types of CAM. However, there were also important differences between the two studies. The Internet group reported seeking CAM because their doctor thought differently about causes and treatments of disease, and because their doctor did not give them the care or human touch that they needed much more frequently than our local sample. Persons indicating these reasons may be less comfortable within the framework of conventional medicine.

Patients who stated that they had used CAM because they thought differently from their doctor about diseases and their treatments were more likely to be satisfied. In contrast, those who had sought CAM after conventional medicine had failed them were less likely to be satisfied. This suggests that health attitudes and beliefs are an important determinant of satisfaction with CAM.

Complementary and alternative medicine use by patients: RESULTS

Posted in Disease | January 4th, 2012

Responses were received from 275 people. Twelve responses were not included in the analysis because the respondents did not indicate whether they had used CAM or no disease information was provided, making it questionable whether they had IBD. Of the 263 eligible responses, 104 were completed during phase 1 and 159 were completed during phase 2. There were no significant differences in demographic or disease characteristics, or in the degree of use or satisfaction with CAM between respondents during phase 1 and phase 2. Therefore, results are reported for the combined group. The demographic and disease characteristics of the study population are shown in Tables 1 and 2. The respondents were predominantly from the United States (63%) and Canada (29%), with only 9% from various other countries.

Forty-six per cent of respondents reported using some form of complementary therapy in the previous two years. Current use was reported by 34%.

In the bivariate analysis, sex, age, education level, type of IBD, disease activity and duration were not predictive of current use of CAM (Table 3). Current users were less likely to have previously had any type of surgery for their IBD or received intravenous or oral steroids than nonus- ers; this was found in both those with ulcerative colitis and those with Crohn’s disease, although the difference was statistically significant only in those with Crohn’s disease. Respondents from elsewhere in the world were more likely to be using CAM (48%) than those in the United States (35%) or Canada (27%), but this difference was not statistically significant. Multivariate analysis indicated that, of these factors, a history of never using oral steroids was the strongest predictor of CAM use (OR 2.3; 95% CI 1.3 to 4.3).

Complementary and alternative medicine use by patients: SUBJECTS AND METHODS

Posted in Disease | January 3rd, 2012

The questionnaire used in our survey of local IBD patients was converted into hypertext markup language and made available over the World Wide Web via the University of Calgary GI Research Group website. (The questionnaire is available from the authors.) The questionnaire included questions on demographic and disease characteristics, and on current and past use of conventional and complementary medicine. There were several questions about the reasons for seeking CAM. Respondents had the option of providing their e-mail address or remaining anonymous. Unless e-mail addresses were provided in this way, the investigators did not have access to identifying information about individual respondents.

Subjects were recruited in two phases over 12 months. In the first phase (June to August 1996), potential subjects were solicited by placing an announcement several times on Internet IBD newsgroups (eg, alt.sup- port.crohns-colitis) and newsletters (eg, IBDList Digest). In the second phase (September 1996 to May 1997), subjects were not solicited by any active means; however, patients could access the questionnaire through several Internet search engines or if they viewed the GI Research Group homepage. The following text was used to recruit subjects.

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Medical Inspection – Health Blog

Low prevalence of VRE gastrointestinal colonization: RESULTS

Low prevalence of VRE gastrointestinal colonization: MATERIALS AND METHODS

Low prevalence of VRE gastrointestinal colonization

Complementary and alternative medicine use by patients: DISCUSSION part 2

Complementary and alternative medicine use by patients: DISCUSSION

Complementary and alternative medicine use by patients: RESULTS

Complementary and alternative medicine use by patients: SUBJECTS AND METHODS

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