1,720,999 research outputs found
Uno studio prospettico sull'infezione da Clostridium difficile nelle malattie infiammatorie croniche intestinali: fattori di rischio, tossino-tipi, sensibilità agli antibiotici, capacità di adesione e impatto sul successivo decorso della malattia
Full text linkClostridium difficile is a Gram positive bacterium rarely present in normal human gut flora that under certain conditions of intestinal dysbiosis, in patients treated with broad-spectrum antibiotics, in hospitalized patients, in immunocompromised subjects and elderly, can cause disease of variable severity referred to as Clostridium Difficile Associated Diarrohea (CDAD). Although in the past Clostridium difficile has been indicated as a possible causal factor in the development of inflammatory bowel disease (also known as IBD), nowadays it is more likely to believe that the IBD may be a risk factor for Clostridium difficile infection (CDI).
CDI in patients with IBD is of increasing importance because the frequency with which it occurs is growing over time, but also because it seems to have a negative impact on health outcomes and because the symptoms induced CDI are indistinguishable from that of an exacerbation of IBD: it is therefore essential to establish an early diagnosis in order to start the most suitable treatment of the case.
The aim of this study was to describe the frequency of the CDI in healthy subjects, subjects not affected by IBD hospitalized with suspected CDAD and patients with IBD, characterize strains of Clostridium difficile isolated from IBD patients (sensitivity to antibiotics, types of toxins, adhesion to the intestinal epithelium), to identify risk factors for CDI in IBD patients (characteristics of the subject, illness, concomitant therapy) and to assess the impact of CDI on the course of IBD, both in symptomatic and asymptomatic carriers.
From January 2010, stool samples from IBD outpatients and inpatients were collected and analyzed at the Gastroenterology unit of the University Hospital of Padua (both in the acute phase of disease and in remission), from patients admitted to the same unit without IBD but with symptoms and medical treatment suggestive of CDAD and from a control group of healthy subjects matched for age and sex.
From the first evaluation (and the collection of the first stool sample), patients with IBD were evaluated at least every six months or in case of relapse or hospitalization for two years. On each sample an anaerobic culture was performed, followed by specific PCR to identify any colonies of Clostridium difficile. Each strain was then characterized by:
- Toxins production
- Antibiotics sensitivity
- Adhesion to Caco-2 cells
- Presence or absence of the tcdC gene in bacterial DNA
Clinical data were collected from patients with IBD to identify any risk factors for CDI.
Patients with IBD have a higher frequency of colonization by Clostridium difficile than the control group: in healthy subjects CDI was detected in 0/55 subjects, in hospitalized IBD patients was found in 5/55 patients (9%) and in IBD outpatients was detected in 9/195 subjects (4.6%).
The production profile of the toxins appears to be different in IBD and non-IBD patients with antibiotic-associated diarrhea, confirming the hypothesis of community-acquired strains rather than hospital-acquired.
Antibiotics sensitivity tests performed on strains isolated from patients with CDAD and patients with IBD showed that all strains are sensitive to metronidazole and vancomycin and markedly resistant to ciprofloxacin.
Strains of Clostridium difficile isolated from patients with active IBD, in remission and from patients with CDAD have shown a different, albeit small, ability to adhere to monolayers of human intestinal epithelial cells (Caco-2), suggesting that strains from active IBD patients have a greater ability to colonize than those from patients in remission.
The tcdC gene was identified in 8% of toxigenic strains isolated from IBD patients (active and in remission) and in 25% of those isolated from patients with CDAD, but the genome had deletions of varying extent, indicating a potential increased virulence of identified strains.
The statistical analysis did not identify any risk factor associated with CDI in IBD.
In the prospective study, CDI has not been identified as a risk factor for clinical or endoscopic relapse or for the need for surgical treatment, demonstrating instead, unexpectedly, to have a protective role against disease flare
Higher levels of knowledge reduce health care costs in patients with inflammatory bowel disease
No full textModelling Inflammatory Bowel Diseases trajectories combining dynamic, multifactorial, Artificial Intelligence-based approaches
Full text linkElectronic questionnaires design and implementation
Full text linkBackground: Nursing and health care research are increasingly using e-questionnaires and e-forms for data collection and survey conduction. The main reason lies in costs, time and data-entry errors containment, increased flexibility, functionality and usability. In spite of this growing usage, no specifc and comprehensive guidelines for designing and submitting e-questionnaires have been produced so far. Objective: The aim of this review is to collect information on the current best practices, taking them from various fields of application. An evaluation of the efficacy of the single indication is provided. Method: A literature review of guidelines currently available on WebSM (Web Survey Methodology) about electronic questionnaire has been performed. Four search strings were used: “Electronic Questionnaire Design”, “Electronic Questionnaire”, “Online Questionnaire” and “Online survey”. Articles’ inclusion criteria were English language, relevant topic in relation to the aim of the research and the publication date from January 1998 to July 2014. Results: The review process led to identify 48 studies. The greater part of guidelines is reported for Web, and e-mail questionnaire, while a lack of indications emerges especially for app and e-questionnaires. Conclusion: Lack of guidelines on e-questionnaires has been found, especially in health care research, increasing the risk of use of ineffective and expensive instruments; more research in this field is needed. © 2017 Minto et al
A nurse-led accelerated procedure for infliximab infusion is well tolerated and effective in patients with inflammatory bowel disease
No full textBackground: Shorter infusions of infliximab for inflammatory bowel disease seem to be as tolerated as standard procedures and nurses may be able to manage them safely.
Aims: To test tolerability and effectiveness of a fast nurse-led infusion procedure and the related patients' satisfaction.
Methods: We retrospectively compared three different regimens adopted in our outpatient infusion unit from 2010 to 2013: Group 1, a standard procedure with two-hour infusions, preceded by hydrocortisone medication (87 patients, 311 infusions); Group 2, a similar regimen without physician supervision (130 patients, 464 infusions); Group 3, a one-hour nurse-led procedure without routine premedication (176 patients, 1356 infusions). Disease characteristics, infusion reactions, infusions per month and patients' satisfaction were recorded.
Results: There were significantly fewer infusion reactions in Group 3 than Group 1 (2.2% versus 5.8% respectively; p = 0.001). The only significant risk factor for side effects was premedication (odds ratio 4.71, 95% confidence interval 2.21-10.02, p < 0.001) which was related to the presence of previous side effects. Number of infusions per month increased by 27% (83 versus 61, p < 0.001) without increasing nurses' workload and patients were satisfied.
Conclusions: Our fast nurse-led procedure was well tolerated, effective and satisfactory for patients. (C) 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved
Wearable Devices for Caloric Intake Assessment: State of Art and Future Developments
Full text linkBackground: The self-monitoring of caloric intake is becoming necessary as the number of pathologies related to eating increases. New wearable devices may help people to automatically record energy assumed in their meals. Objective: The present review collects the released articles about wearable devices or method for automatic caloric assessments. Method: A literature research has been performed with PubMed, Google Scholar, Scopus and ClinicalTrials.gov search engines, considering released articles regarding applications of wearable devices in eating environment, from 2005 onwards. Results: Several tools allow caloric assessment and food registration: wearable devices counting the number of bites ingested by the user, instruments detecting swallows and chewings, methods that analyse food with digital photography. All of them still require more validation and improvement. Conclusion: Automatic recording of caloric intake through wearable devices is a promising method to monitor body weight and eating habits in clinical and non-clinical settings, and the research is still going on. © 2017 Magrini et al
Anchoring Vignettes in EQ-5D-5L Questionnaire: Validation of a New Instrument
Full text linkHealth Related Quality of Life (HRQoL) is an indicator of patient's physical, psychological and social life. HRQoL is influenced by experience, beliefs, perceptions and expectations, and measures subjective perspective of the patient himself. EQ-5D-5L and SF-12 questionnaires are validated instruments useful to measure HRQoL, increasingly administered in electronic formats
Perception of health and illness and quality of life after total thyroidectomy for differentiated thyroid carcinoma: the PERSAM study
No full textBackground: Differentiated thyroid carcinoma is the most common endocrine neoplasm; several studies have shown that individuals perceive the disease as being more severe than it actually is, resulting in a reduced quality of life. The primary aim of this study is to assess the quality of life and perception of illness among patients admitted for radiometabolic therapy, post total thyroidectomy for differentiated thyroid carcinoma. The secondary aim is to identify which patient characteristics are associated with a lower quality of life in order to improve and personalize care. Methods: The study was conducted at the UOC of Radiotherapy Veneto Institute of Oncology IOV-IRCCS in Padua, Italy. Three questionnaires were administered: Psychological General Well-Being Index (PGWBI), the Illness Perception Questionnaire (IPQ-R) and the Short Form Survey (SF-12). A descriptive statistics analysis and multiple linear regression models were performed to explore the relationship between some of the variables. Results: Significant associations emerged between the type of surgery and higher values on the PGWBI questionnaire (P = 0.022) and the score obtained in the ‘emotional representations’ dimension of the IPQ-R questionnaire (P = 0.028). Pathology staging was statistically significantly (P = 0.026) associated with the score obtained in the dimension ‘identity’; age with the scores obtained in the dimensions ‘emotional representations’ (P = 0.035), ‘personal control’ (P = 0.004), ‘consistency with pathology’ (P < 0.001) and ‘causes’ (P = 0.004). Conclusions: There is evidence of moderate distress in psychological well-being and good perception of pathology. There is less understanding of the disease in individuals with stage 3 and 4 thyroid cancer, in those who have undergone total thyroidectomy without lymphadenectomy and who are aged over 60. Physical well-being: limitations in self-care and moderately physically demanding activities. Mental health: more information to patients decreases the degree of stress and promotes ‘positive’ emotions. Physical health status: a long-term activity program, characterized by aerobic exercises to be performed in groups or at home, is useful. This study allows to transpose the results into clinical practice, evaluating the possibility and methods of providing personalized care to patients
A Survey on Biostatisticians Serving in the Italian Ethics Committees
Full text linkBackground: Italian ethics committees (ECs) have the responsibility for evaluating and monitoring clinical research.
Methods: An electronic survey targeted to the biostatisticians operating in the 95 ECs in Italy, was launched in
November 2016. Several aspects were explored such as education, job title, training in biostatistics and experience
in the evaluation of protocols within the EC.
Results: Seventy case report forms were returned (74%), and the response rate was highest for ECs located in
the South (78%) and lowest in the North (51%). The biostatisticians in the respondent ECs were prevalently male,
aged 50-60 years, with postgraduate education in medical specialties and statistics. The annual workload varied
depending on the type of institution and geographical area, with an annual median number of protocols examined
ranging from 80 in hospital ECs to 198 in university hospital ECs, and from 80 to 108, in the South and the Centre,
respectively. Of these, 40% were observational study protocols. The EC biostatisticians proposed to reject 5% of
protocols and to suspend with the request of clarification or amendments 10%. Only 61% and 79% of these opinions,
respectively, were regarded as binding by the other EC members.
Conclusion: The biostatistician will not be able to play a significant role in the EC as long as the required skill-set
remains vague and his/her opinion on a protocol is underrated
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