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Decline in depression symptoms followed less than standard number of ketamine doses
Ketamine was 80% effective at decreasing depression symptoms, in a study of 100 depression patients who received less frequent and lower total doses of ketamine than are typically administered to treat depression.
Each study participant received no more than one ketamine intravenous infusion per week, with 4.3 having been the average total number of ketamine infusions received by a patient during the study. The frequency with which an infusion was received and the total number of infusions received by a patient were tailored to each patient’s responses to the therapy, according to the study’s author, Dr. Theodore Henderson. This study used a schedule of treatments for patients that differed from the established protocol for ketamine usage as an antidepressant, which is 3 times per week.
Prior to receiving the intravenous ketamine infusions, study participant’s Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) score was 17.87 plus or minus 2.8 points, which corresponds to being severely depressed. The QIDS-SR score for each of the 80 study participants who responded to the therapy decreased by 10.8 plus or minus 3.5 points. The QIDS-SR of each of the 20 non-responders to the therapy changed by 0.8 plus or minus 1.8 points.
This study showed “clinical improvement with much fewer infusions for most patients. From a mechanistic standpoint, this can only be possible if ketamine is inducing increased BDNF [brain-derived neurotrophic factor] which leads to lasting changes in synapses, dendrites, and neuronal circuits,” Dr. Henderson said.
The study participants comprised 80 patients with recurrent unipolar depression and 20 patients with recurrent bipolar depression from Neuro-Luminance Ketamine Infusion Centers. Side effects experienced by the patients included elevated blood pressure, nausea, and dizziness, which was very common.
“Further controlled studies of the best clinical methods for ketamine infusion therapy are encouraged.” Dr. Henderson said.
Read the study in Neural Regeneration Research (doi: 10.4103/1673-5374.177708).
Ketamine was 80% effective at decreasing depression symptoms, in a study of 100 depression patients who received less frequent and lower total doses of ketamine than are typically administered to treat depression.
Each study participant received no more than one ketamine intravenous infusion per week, with 4.3 having been the average total number of ketamine infusions received by a patient during the study. The frequency with which an infusion was received and the total number of infusions received by a patient were tailored to each patient’s responses to the therapy, according to the study’s author, Dr. Theodore Henderson. This study used a schedule of treatments for patients that differed from the established protocol for ketamine usage as an antidepressant, which is 3 times per week.
Prior to receiving the intravenous ketamine infusions, study participant’s Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) score was 17.87 plus or minus 2.8 points, which corresponds to being severely depressed. The QIDS-SR score for each of the 80 study participants who responded to the therapy decreased by 10.8 plus or minus 3.5 points. The QIDS-SR of each of the 20 non-responders to the therapy changed by 0.8 plus or minus 1.8 points.
This study showed “clinical improvement with much fewer infusions for most patients. From a mechanistic standpoint, this can only be possible if ketamine is inducing increased BDNF [brain-derived neurotrophic factor] which leads to lasting changes in synapses, dendrites, and neuronal circuits,” Dr. Henderson said.
The study participants comprised 80 patients with recurrent unipolar depression and 20 patients with recurrent bipolar depression from Neuro-Luminance Ketamine Infusion Centers. Side effects experienced by the patients included elevated blood pressure, nausea, and dizziness, which was very common.
“Further controlled studies of the best clinical methods for ketamine infusion therapy are encouraged.” Dr. Henderson said.
Read the study in Neural Regeneration Research (doi: 10.4103/1673-5374.177708).
Ketamine was 80% effective at decreasing depression symptoms, in a study of 100 depression patients who received less frequent and lower total doses of ketamine than are typically administered to treat depression.
Each study participant received no more than one ketamine intravenous infusion per week, with 4.3 having been the average total number of ketamine infusions received by a patient during the study. The frequency with which an infusion was received and the total number of infusions received by a patient were tailored to each patient’s responses to the therapy, according to the study’s author, Dr. Theodore Henderson. This study used a schedule of treatments for patients that differed from the established protocol for ketamine usage as an antidepressant, which is 3 times per week.
Prior to receiving the intravenous ketamine infusions, study participant’s Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) score was 17.87 plus or minus 2.8 points, which corresponds to being severely depressed. The QIDS-SR score for each of the 80 study participants who responded to the therapy decreased by 10.8 plus or minus 3.5 points. The QIDS-SR of each of the 20 non-responders to the therapy changed by 0.8 plus or minus 1.8 points.
This study showed “clinical improvement with much fewer infusions for most patients. From a mechanistic standpoint, this can only be possible if ketamine is inducing increased BDNF [brain-derived neurotrophic factor] which leads to lasting changes in synapses, dendrites, and neuronal circuits,” Dr. Henderson said.
The study participants comprised 80 patients with recurrent unipolar depression and 20 patients with recurrent bipolar depression from Neuro-Luminance Ketamine Infusion Centers. Side effects experienced by the patients included elevated blood pressure, nausea, and dizziness, which was very common.
“Further controlled studies of the best clinical methods for ketamine infusion therapy are encouraged.” Dr. Henderson said.
Read the study in Neural Regeneration Research (doi: 10.4103/1673-5374.177708).
FROM NEURAL REGENERATION RESEARCH
Better control of asymptomatic C. difficile needed in communities
Clostridium difficile is transmitted at higher rates in hospitals or long-term care facilities than in community settings, but more efforts need to be directed at reducing community transmission of the infection, report David P. Durham, Ph.D., and his associates.
Hospitalized symptomatic patients transmit C. difficile at a rate 15 times that of patients who are asymptomatic, according to a model created from U.S. national databases described in the paper. Long-term care facility (LTCF) residents transmit C. difficile at a rate of 27% that of hospitalized patients, while people in the community transmit the infection at a rate of less than 0.1% that of hospitalized patients, the model found.
“Despite the lower community transmission rate, we found that because of the much larger pool of colonized persons in the community, interventions that reduce community transmission hold substantial potential to reduce hospital-onset C. difficile infection by reducing the number of patients entering the hospital with asymptomatic colonization,” reported Dr. Durham, associate research scientist in epidemiology at Yale University, New Haven, Conn., and his associates.
The researchers also estimated the effect of transmission-control interventions on C. difficile incidence by computing the percentage reduction in hospital-onset C. difficile, community-onset C. difficile, and LTCF C. difficile per percentage in improvement in hospital C. difficile diagnosis rate, effectiveness of isolation protocols, overall hospital hygiene, transmission in the community, and transmission in an LTCF.
“We found that C. difficile infection diagnosis rate, effectiveness of isolation, overall hospital hygiene, and transmission in the community, but not transmission in an LTCF, affected hospital-onset C. difficile infection,” the researchers wrote. “In addition, community-onset C. difficile infection and LTCF C. difficile infection were not affected by hospital-based transmission interventions.”
Additionally, as the relative risk for antimicrobial drug class prescribed increased in each of the three settings, the C. difficile incidence increased within the respective setting.
The researchers suggested that the use of vaccines and other toxin-targeting treatments, nontoxigenic C. difficile, and monoclonal antibodies could lead to reductions in primary C. difficile cases and transmission of the infection.
“These results underscore the need for empirical quantification of community-associated transmission and the need of understanding transmission dynamics in all settings when evaluating C. difficile interventions and control strategies,” researchers said.
Read the study in Emerging Infectious Diseases (doi: 10.3201.eid2204.1540455).
Clostridium difficile is transmitted at higher rates in hospitals or long-term care facilities than in community settings, but more efforts need to be directed at reducing community transmission of the infection, report David P. Durham, Ph.D., and his associates.
Hospitalized symptomatic patients transmit C. difficile at a rate 15 times that of patients who are asymptomatic, according to a model created from U.S. national databases described in the paper. Long-term care facility (LTCF) residents transmit C. difficile at a rate of 27% that of hospitalized patients, while people in the community transmit the infection at a rate of less than 0.1% that of hospitalized patients, the model found.
“Despite the lower community transmission rate, we found that because of the much larger pool of colonized persons in the community, interventions that reduce community transmission hold substantial potential to reduce hospital-onset C. difficile infection by reducing the number of patients entering the hospital with asymptomatic colonization,” reported Dr. Durham, associate research scientist in epidemiology at Yale University, New Haven, Conn., and his associates.
The researchers also estimated the effect of transmission-control interventions on C. difficile incidence by computing the percentage reduction in hospital-onset C. difficile, community-onset C. difficile, and LTCF C. difficile per percentage in improvement in hospital C. difficile diagnosis rate, effectiveness of isolation protocols, overall hospital hygiene, transmission in the community, and transmission in an LTCF.
“We found that C. difficile infection diagnosis rate, effectiveness of isolation, overall hospital hygiene, and transmission in the community, but not transmission in an LTCF, affected hospital-onset C. difficile infection,” the researchers wrote. “In addition, community-onset C. difficile infection and LTCF C. difficile infection were not affected by hospital-based transmission interventions.”
Additionally, as the relative risk for antimicrobial drug class prescribed increased in each of the three settings, the C. difficile incidence increased within the respective setting.
The researchers suggested that the use of vaccines and other toxin-targeting treatments, nontoxigenic C. difficile, and monoclonal antibodies could lead to reductions in primary C. difficile cases and transmission of the infection.
“These results underscore the need for empirical quantification of community-associated transmission and the need of understanding transmission dynamics in all settings when evaluating C. difficile interventions and control strategies,” researchers said.
Read the study in Emerging Infectious Diseases (doi: 10.3201.eid2204.1540455).
Clostridium difficile is transmitted at higher rates in hospitals or long-term care facilities than in community settings, but more efforts need to be directed at reducing community transmission of the infection, report David P. Durham, Ph.D., and his associates.
Hospitalized symptomatic patients transmit C. difficile at a rate 15 times that of patients who are asymptomatic, according to a model created from U.S. national databases described in the paper. Long-term care facility (LTCF) residents transmit C. difficile at a rate of 27% that of hospitalized patients, while people in the community transmit the infection at a rate of less than 0.1% that of hospitalized patients, the model found.
“Despite the lower community transmission rate, we found that because of the much larger pool of colonized persons in the community, interventions that reduce community transmission hold substantial potential to reduce hospital-onset C. difficile infection by reducing the number of patients entering the hospital with asymptomatic colonization,” reported Dr. Durham, associate research scientist in epidemiology at Yale University, New Haven, Conn., and his associates.
The researchers also estimated the effect of transmission-control interventions on C. difficile incidence by computing the percentage reduction in hospital-onset C. difficile, community-onset C. difficile, and LTCF C. difficile per percentage in improvement in hospital C. difficile diagnosis rate, effectiveness of isolation protocols, overall hospital hygiene, transmission in the community, and transmission in an LTCF.
“We found that C. difficile infection diagnosis rate, effectiveness of isolation, overall hospital hygiene, and transmission in the community, but not transmission in an LTCF, affected hospital-onset C. difficile infection,” the researchers wrote. “In addition, community-onset C. difficile infection and LTCF C. difficile infection were not affected by hospital-based transmission interventions.”
Additionally, as the relative risk for antimicrobial drug class prescribed increased in each of the three settings, the C. difficile incidence increased within the respective setting.
The researchers suggested that the use of vaccines and other toxin-targeting treatments, nontoxigenic C. difficile, and monoclonal antibodies could lead to reductions in primary C. difficile cases and transmission of the infection.
“These results underscore the need for empirical quantification of community-associated transmission and the need of understanding transmission dynamics in all settings when evaluating C. difficile interventions and control strategies,” researchers said.
Read the study in Emerging Infectious Diseases (doi: 10.3201.eid2204.1540455).
FROM EMERGING INFECTIOUS DISEASES
Pilot study shows potential of transcranial direct current stimulation in poststroke motor recovery
Anodal transcranial direct current stimulation (tDCS) combined with motor training in stroke patients led to greater improvements in motor function, compared with motor training alone, in a double-blind randomized trial that was controlled with a sham intervention.
“We report long-term improvements in upper limb ability in patients receiving repeated sessions of anodal tDCS to the ipsilesional motor cortex compared to the sham-treated group when tDCS was paired with motor training. We also found that these clinical improvements were associated with increased activation of ipsilesional motor cortical areas,” said Claire Allman of the University of Oxford (England) and her colleagues.
Participants in the U.K. study included 24 individuals, who had had a single unilateral ischemic or hemorrhagic stroke affecting motor function in the contralesional hand at least 6 months prior to the start of the study. All patients participated in nine daily, supervised, 1-hour weekday sessions of the motor training program, the Graded Repetitive Arm Supplementary Program. For the first 20 minutes of each session, brain stimulations via tDCS electrodes were delivered to 11 patients comprising the experimental group. The 13 patients in the control group received a sham treatment, while electrodes were positioned on their scalps, during the first 20 minutes of each session. The researchers used the Upper Extremity Fugl-Meyer Assessment, the Action Research Arm Test, and the Wolf Motor Function Test to assess upper limb function before and after each patient’s sessions. Neuroimaging analyses were performed using MRI on 11 participants in the experimental group and 11 participants in the control group, both before and after the interventions, as well.
Patients who received the anodal tDCS earned greater scores in the Action Research Arm Test (P = .045) and the Wolf Motor Function Test (P = .001) than did patients in the control group, at 3 months following the intervention. The differences between the Extremity Fugl-Meyer Assessment scores of participants in the two groups at the same point in time were not statistically significant.
There were also “greater increases in [functional MRI] activation and gray matter volume in ipsilesional motor cortical areas in the anodal tDCS group compared to the sham group,” the investigators reported.
Among the researchers’ suggestions for future research on the effects of tDCS on stroke patients were for such studies to include more patients, a less intensive motor training regimen, and a group of patients who receive tDCS without undergoing motor training.
The authors reported that they have no competing interests.
Read the study in Science Translational Medicine (doi: 10.1126/scitranslmed.aad5651).
Anodal transcranial direct current stimulation (tDCS) combined with motor training in stroke patients led to greater improvements in motor function, compared with motor training alone, in a double-blind randomized trial that was controlled with a sham intervention.
“We report long-term improvements in upper limb ability in patients receiving repeated sessions of anodal tDCS to the ipsilesional motor cortex compared to the sham-treated group when tDCS was paired with motor training. We also found that these clinical improvements were associated with increased activation of ipsilesional motor cortical areas,” said Claire Allman of the University of Oxford (England) and her colleagues.
Participants in the U.K. study included 24 individuals, who had had a single unilateral ischemic or hemorrhagic stroke affecting motor function in the contralesional hand at least 6 months prior to the start of the study. All patients participated in nine daily, supervised, 1-hour weekday sessions of the motor training program, the Graded Repetitive Arm Supplementary Program. For the first 20 minutes of each session, brain stimulations via tDCS electrodes were delivered to 11 patients comprising the experimental group. The 13 patients in the control group received a sham treatment, while electrodes were positioned on their scalps, during the first 20 minutes of each session. The researchers used the Upper Extremity Fugl-Meyer Assessment, the Action Research Arm Test, and the Wolf Motor Function Test to assess upper limb function before and after each patient’s sessions. Neuroimaging analyses were performed using MRI on 11 participants in the experimental group and 11 participants in the control group, both before and after the interventions, as well.
Patients who received the anodal tDCS earned greater scores in the Action Research Arm Test (P = .045) and the Wolf Motor Function Test (P = .001) than did patients in the control group, at 3 months following the intervention. The differences between the Extremity Fugl-Meyer Assessment scores of participants in the two groups at the same point in time were not statistically significant.
There were also “greater increases in [functional MRI] activation and gray matter volume in ipsilesional motor cortical areas in the anodal tDCS group compared to the sham group,” the investigators reported.
Among the researchers’ suggestions for future research on the effects of tDCS on stroke patients were for such studies to include more patients, a less intensive motor training regimen, and a group of patients who receive tDCS without undergoing motor training.
The authors reported that they have no competing interests.
Read the study in Science Translational Medicine (doi: 10.1126/scitranslmed.aad5651).
Anodal transcranial direct current stimulation (tDCS) combined with motor training in stroke patients led to greater improvements in motor function, compared with motor training alone, in a double-blind randomized trial that was controlled with a sham intervention.
“We report long-term improvements in upper limb ability in patients receiving repeated sessions of anodal tDCS to the ipsilesional motor cortex compared to the sham-treated group when tDCS was paired with motor training. We also found that these clinical improvements were associated with increased activation of ipsilesional motor cortical areas,” said Claire Allman of the University of Oxford (England) and her colleagues.
Participants in the U.K. study included 24 individuals, who had had a single unilateral ischemic or hemorrhagic stroke affecting motor function in the contralesional hand at least 6 months prior to the start of the study. All patients participated in nine daily, supervised, 1-hour weekday sessions of the motor training program, the Graded Repetitive Arm Supplementary Program. For the first 20 minutes of each session, brain stimulations via tDCS electrodes were delivered to 11 patients comprising the experimental group. The 13 patients in the control group received a sham treatment, while electrodes were positioned on their scalps, during the first 20 minutes of each session. The researchers used the Upper Extremity Fugl-Meyer Assessment, the Action Research Arm Test, and the Wolf Motor Function Test to assess upper limb function before and after each patient’s sessions. Neuroimaging analyses were performed using MRI on 11 participants in the experimental group and 11 participants in the control group, both before and after the interventions, as well.
Patients who received the anodal tDCS earned greater scores in the Action Research Arm Test (P = .045) and the Wolf Motor Function Test (P = .001) than did patients in the control group, at 3 months following the intervention. The differences between the Extremity Fugl-Meyer Assessment scores of participants in the two groups at the same point in time were not statistically significant.
There were also “greater increases in [functional MRI] activation and gray matter volume in ipsilesional motor cortical areas in the anodal tDCS group compared to the sham group,” the investigators reported.
Among the researchers’ suggestions for future research on the effects of tDCS on stroke patients were for such studies to include more patients, a less intensive motor training regimen, and a group of patients who receive tDCS without undergoing motor training.
The authors reported that they have no competing interests.
Read the study in Science Translational Medicine (doi: 10.1126/scitranslmed.aad5651).
FROM SCIENCE TRANSLATIONAL MEDICINE
Study: Two Varicella Vaccination Doses More Effective Than One
Two-dose varicella vaccinations were more effective and resulted in decreased risk of varicella severity and some disease characteristics than did one-dose varicella vaccinations, in a case-control study of children living in two communities in the United States.
Two doses of the vaccine were 93.6% effective against all clinically diagnosed varicella and 97.9% effective against moderate to severe varicella, compared with children receiving no vaccine, among subjects aged 4 years and older. A single dose of the vaccine was 75.6% effective against all clinically diagnosed varicella and 78.1% effective against moderate or severe disease, compared with no vaccine.
Cases of varicella in patients who had two doses of the vaccine were more likely to involve rashes that resolved in less than 1 week (P = .01) and were less likely to involve vesicular rashes (P = .01), among breakthrough cases in patients aged 4 years and older, reported Dana Perella of the Philadelphia Department of Public Health, and her colleagues. They investigated 125 clinically diagnosed cases of varicella and 408 matched controls from May 2009 through June 2011. The study participants, aged 1-18 years, were residents of West Philadelphia and the Antelope Valley are of Northern Los Angeles.
“With superior protection provided by the two-dose varicella vaccination, compared with the one-dose regimen as demonstrated in our study and others, it will be important to expand school immunization requirements to include two-dose varicella vaccination,” the researchers wrote.
Read the study in Pediatrics (doi: 10.1542/peds.2015-2802).
Two-dose varicella vaccinations were more effective and resulted in decreased risk of varicella severity and some disease characteristics than did one-dose varicella vaccinations, in a case-control study of children living in two communities in the United States.
Two doses of the vaccine were 93.6% effective against all clinically diagnosed varicella and 97.9% effective against moderate to severe varicella, compared with children receiving no vaccine, among subjects aged 4 years and older. A single dose of the vaccine was 75.6% effective against all clinically diagnosed varicella and 78.1% effective against moderate or severe disease, compared with no vaccine.
Cases of varicella in patients who had two doses of the vaccine were more likely to involve rashes that resolved in less than 1 week (P = .01) and were less likely to involve vesicular rashes (P = .01), among breakthrough cases in patients aged 4 years and older, reported Dana Perella of the Philadelphia Department of Public Health, and her colleagues. They investigated 125 clinically diagnosed cases of varicella and 408 matched controls from May 2009 through June 2011. The study participants, aged 1-18 years, were residents of West Philadelphia and the Antelope Valley are of Northern Los Angeles.
“With superior protection provided by the two-dose varicella vaccination, compared with the one-dose regimen as demonstrated in our study and others, it will be important to expand school immunization requirements to include two-dose varicella vaccination,” the researchers wrote.
Read the study in Pediatrics (doi: 10.1542/peds.2015-2802).
Two-dose varicella vaccinations were more effective and resulted in decreased risk of varicella severity and some disease characteristics than did one-dose varicella vaccinations, in a case-control study of children living in two communities in the United States.
Two doses of the vaccine were 93.6% effective against all clinically diagnosed varicella and 97.9% effective against moderate to severe varicella, compared with children receiving no vaccine, among subjects aged 4 years and older. A single dose of the vaccine was 75.6% effective against all clinically diagnosed varicella and 78.1% effective against moderate or severe disease, compared with no vaccine.
Cases of varicella in patients who had two doses of the vaccine were more likely to involve rashes that resolved in less than 1 week (P = .01) and were less likely to involve vesicular rashes (P = .01), among breakthrough cases in patients aged 4 years and older, reported Dana Perella of the Philadelphia Department of Public Health, and her colleagues. They investigated 125 clinically diagnosed cases of varicella and 408 matched controls from May 2009 through June 2011. The study participants, aged 1-18 years, were residents of West Philadelphia and the Antelope Valley are of Northern Los Angeles.
“With superior protection provided by the two-dose varicella vaccination, compared with the one-dose regimen as demonstrated in our study and others, it will be important to expand school immunization requirements to include two-dose varicella vaccination,” the researchers wrote.
Read the study in Pediatrics (doi: 10.1542/peds.2015-2802).
FROM PEDIATRICS
Study: Two varicella vaccination doses more effective than one
Two-dose varicella vaccinations were more effective and resulted in decreased risk of varicella severity and some disease characteristics than did one-dose varicella vaccinations, in a case-control study of children living in two communities in the United States.
Two doses of the vaccine were 93.6% effective against all clinically diagnosed varicella and 97.9% effective against moderate to severe varicella, compared with children receiving no vaccine, among subjects aged 4 years and older. A single dose of the vaccine was 75.6% effective against all clinically diagnosed varicella and 78.1% effective against moderate or severe disease, compared with no vaccine.
Cases of varicella in patients who had two doses of the vaccine were more likely to involve rashes that resolved in less than 1 week (P = .01) and were less likely to involve vesicular rashes (P = .01), among breakthrough cases in patients aged 4 years and older, reported Dana Perella of the Philadelphia Department of Public Health, and her colleagues. They investigated 125 clinically diagnosed cases of varicella and 408 matched controls from May 2009 through June 2011. The study participants, aged 1-18 years, were residents of West Philadelphia and the Antelope Valley are of Northern Los Angeles.
“With superior protection provided by the two-dose varicella vaccination, compared with the one-dose regimen as demonstrated in our study and others, it will be important to expand school immunization requirements to include two-dose varicella vaccination,” the researchers wrote.
Read the study in Pediatrics (doi: 10.1542/peds.2015-2802).
Two-dose varicella vaccinations were more effective and resulted in decreased risk of varicella severity and some disease characteristics than did one-dose varicella vaccinations, in a case-control study of children living in two communities in the United States.
Two doses of the vaccine were 93.6% effective against all clinically diagnosed varicella and 97.9% effective against moderate to severe varicella, compared with children receiving no vaccine, among subjects aged 4 years and older. A single dose of the vaccine was 75.6% effective against all clinically diagnosed varicella and 78.1% effective against moderate or severe disease, compared with no vaccine.
Cases of varicella in patients who had two doses of the vaccine were more likely to involve rashes that resolved in less than 1 week (P = .01) and were less likely to involve vesicular rashes (P = .01), among breakthrough cases in patients aged 4 years and older, reported Dana Perella of the Philadelphia Department of Public Health, and her colleagues. They investigated 125 clinically diagnosed cases of varicella and 408 matched controls from May 2009 through June 2011. The study participants, aged 1-18 years, were residents of West Philadelphia and the Antelope Valley are of Northern Los Angeles.
“With superior protection provided by the two-dose varicella vaccination, compared with the one-dose regimen as demonstrated in our study and others, it will be important to expand school immunization requirements to include two-dose varicella vaccination,” the researchers wrote.
Read the study in Pediatrics (doi: 10.1542/peds.2015-2802).
Two-dose varicella vaccinations were more effective and resulted in decreased risk of varicella severity and some disease characteristics than did one-dose varicella vaccinations, in a case-control study of children living in two communities in the United States.
Two doses of the vaccine were 93.6% effective against all clinically diagnosed varicella and 97.9% effective against moderate to severe varicella, compared with children receiving no vaccine, among subjects aged 4 years and older. A single dose of the vaccine was 75.6% effective against all clinically diagnosed varicella and 78.1% effective against moderate or severe disease, compared with no vaccine.
Cases of varicella in patients who had two doses of the vaccine were more likely to involve rashes that resolved in less than 1 week (P = .01) and were less likely to involve vesicular rashes (P = .01), among breakthrough cases in patients aged 4 years and older, reported Dana Perella of the Philadelphia Department of Public Health, and her colleagues. They investigated 125 clinically diagnosed cases of varicella and 408 matched controls from May 2009 through June 2011. The study participants, aged 1-18 years, were residents of West Philadelphia and the Antelope Valley are of Northern Los Angeles.
“With superior protection provided by the two-dose varicella vaccination, compared with the one-dose regimen as demonstrated in our study and others, it will be important to expand school immunization requirements to include two-dose varicella vaccination,” the researchers wrote.
Read the study in Pediatrics (doi: 10.1542/peds.2015-2802).
FROM PEDIATRICS
Quitting smoking plus low-dose helical CT reduces lung cancer death risk
Smoking abstinence for 7 years results in a 20% reduction in death from lung cancer – a benefit that is comparable to three rounds of annual screening with low-dose helical computed tomography (LDCT) – in asymptomatic individuals with at least a 30–pack-year smoking history, based on a secondary analysis of 50,263 participants in the National Lung Screening Trial (NLST).
Not smoking for 7 years plus screening for lung cancer with LDCT conferred an additional 10% reduction in lung cancer mortality. Similar patterns for smoking cessation benefits were noted for overall mortality, as well.
“This study is the first to quantify the benefit of smoking cessation coupled with lung cancer screening in a cohort that is asymptomatic,” wrote Dr. Nichole T. Tanner of the Medical University of South Carolina, Charleston, and her colleagues (Am J Respir Crit Care. 2016 March 1. doi: 10.1164/rccm.201507-1420OC). “[Its] findings highlight the importance of integrating smoking cessation efforts into lung cancer screening programs.”
The NLST subset study included 47,902 participants who self-identified as non-Hispanic white and 2,361 who self-identified as non-Hispanic black; 24,190 were current smokers and 26,073 were former smokers who had quit within the 15 years prior to entering the study. Participants ranged in age from 55 to 74 years at the time of randomization and had a 30–pack-year or more history of cigarette smoking.
All participants were screened for lung cancer with either LDCT or a chest radiograph examination. A 20% reduction in death from lung cancer was seen in those who had abstained from smoking for 7 years and were screened for lung cancer with a chest radiograph and in those who had undergone three rounds of annual screening for lung cancer with LDCT and continued to smoke.
For former smokers screened with LDCT, the risk of dying of lung cancer decreased at a faster rate than it did for those screened with chest radiographs. For each additional year an individual abstained from smoking and had an LDCT screen, the risk of dying of lung cancer decreased by 9%. For those individuals who abstained from smoking and had been screened with a chest x-ray, the risk of dying of lung cancer decreased by 3%.
In contrast, there was a 10% increase in lung cancer mortality for each additional 10 pack-years smoked for those screened with LDCT (HR, 1.10; 95% CI, 1.08-1.13). This “did not vary significantly in the chest radiograph group,” according to the researchers.
In both screening groups, “an additional 6% risk of death from all causes (was seen) for each additional 10 pack-years smoked.”
In addition, black study participants who had quit smoking at trial entry had “a more pronounced benefit” from having done so, compared with the white study participants (HR, 0.53, 95% CI, 0.28-1.0).
The NLST was sponsored by the National Cancer Institute. Dr. Nichole T. Tanner, one of this secondary analysis’s authors reported receiving grants from ACCP OneBreath Foundation for her work on this project and grants from Olympus America, Cook, and the American Cancer Society for other work. Disclosures for all investigators are available at atsjournals.org.
This secondary analysis was limited by the fact that the National Lung Screening Trial “does not have information about smoking cessation or persistence during the trial.”
The finding of black former smokers having a hazard rate for lung cancer mortality of 0.53, compared with white former smokers, was reassuring, because “there is evidence that African Americans are at higher risk for lung cancer at lower smoking intensities than whites.”
While this secondary analysis suggests that screening for lung cancer can reduce lung cancer death risk, lung cancer screening alone is not adequate for preventing the disease. Screening must be “linked to smoking cessation efforts in those who are current smokers” and may need to follow criteria that are different from those used in the NLST.
“Implementation of lung cancer screening will be a serious challenge that must be linked to smoking cessation efforts in those who are current smokers at the time they enter a screening program, both for Centers for Medicare & Medicaid Services reimbursement and for medical appropriateness.”
Dr. Christine D. Berg is with Johns Hopkins Medicine, Baltimore, and the division of cancer epidemiology and prevention at the National Cancer Institute, Bethesda, Md. She made these remarks in an editorial accompanying Dr. Tanner’s report (J Respir Crit Care. 2016 March 1. doi: 10.1164/rccm.201511-2270ED). She reported receiving personal fees from Medial CS, and she was the study director of the NLST.
This secondary analysis was limited by the fact that the National Lung Screening Trial “does not have information about smoking cessation or persistence during the trial.”
The finding of black former smokers having a hazard rate for lung cancer mortality of 0.53, compared with white former smokers, was reassuring, because “there is evidence that African Americans are at higher risk for lung cancer at lower smoking intensities than whites.”
While this secondary analysis suggests that screening for lung cancer can reduce lung cancer death risk, lung cancer screening alone is not adequate for preventing the disease. Screening must be “linked to smoking cessation efforts in those who are current smokers” and may need to follow criteria that are different from those used in the NLST.
“Implementation of lung cancer screening will be a serious challenge that must be linked to smoking cessation efforts in those who are current smokers at the time they enter a screening program, both for Centers for Medicare & Medicaid Services reimbursement and for medical appropriateness.”
Dr. Christine D. Berg is with Johns Hopkins Medicine, Baltimore, and the division of cancer epidemiology and prevention at the National Cancer Institute, Bethesda, Md. She made these remarks in an editorial accompanying Dr. Tanner’s report (J Respir Crit Care. 2016 March 1. doi: 10.1164/rccm.201511-2270ED). She reported receiving personal fees from Medial CS, and she was the study director of the NLST.
This secondary analysis was limited by the fact that the National Lung Screening Trial “does not have information about smoking cessation or persistence during the trial.”
The finding of black former smokers having a hazard rate for lung cancer mortality of 0.53, compared with white former smokers, was reassuring, because “there is evidence that African Americans are at higher risk for lung cancer at lower smoking intensities than whites.”
While this secondary analysis suggests that screening for lung cancer can reduce lung cancer death risk, lung cancer screening alone is not adequate for preventing the disease. Screening must be “linked to smoking cessation efforts in those who are current smokers” and may need to follow criteria that are different from those used in the NLST.
“Implementation of lung cancer screening will be a serious challenge that must be linked to smoking cessation efforts in those who are current smokers at the time they enter a screening program, both for Centers for Medicare & Medicaid Services reimbursement and for medical appropriateness.”
Dr. Christine D. Berg is with Johns Hopkins Medicine, Baltimore, and the division of cancer epidemiology and prevention at the National Cancer Institute, Bethesda, Md. She made these remarks in an editorial accompanying Dr. Tanner’s report (J Respir Crit Care. 2016 March 1. doi: 10.1164/rccm.201511-2270ED). She reported receiving personal fees from Medial CS, and she was the study director of the NLST.
Smoking abstinence for 7 years results in a 20% reduction in death from lung cancer – a benefit that is comparable to three rounds of annual screening with low-dose helical computed tomography (LDCT) – in asymptomatic individuals with at least a 30–pack-year smoking history, based on a secondary analysis of 50,263 participants in the National Lung Screening Trial (NLST).
Not smoking for 7 years plus screening for lung cancer with LDCT conferred an additional 10% reduction in lung cancer mortality. Similar patterns for smoking cessation benefits were noted for overall mortality, as well.
“This study is the first to quantify the benefit of smoking cessation coupled with lung cancer screening in a cohort that is asymptomatic,” wrote Dr. Nichole T. Tanner of the Medical University of South Carolina, Charleston, and her colleagues (Am J Respir Crit Care. 2016 March 1. doi: 10.1164/rccm.201507-1420OC). “[Its] findings highlight the importance of integrating smoking cessation efforts into lung cancer screening programs.”
The NLST subset study included 47,902 participants who self-identified as non-Hispanic white and 2,361 who self-identified as non-Hispanic black; 24,190 were current smokers and 26,073 were former smokers who had quit within the 15 years prior to entering the study. Participants ranged in age from 55 to 74 years at the time of randomization and had a 30–pack-year or more history of cigarette smoking.
All participants were screened for lung cancer with either LDCT or a chest radiograph examination. A 20% reduction in death from lung cancer was seen in those who had abstained from smoking for 7 years and were screened for lung cancer with a chest radiograph and in those who had undergone three rounds of annual screening for lung cancer with LDCT and continued to smoke.
For former smokers screened with LDCT, the risk of dying of lung cancer decreased at a faster rate than it did for those screened with chest radiographs. For each additional year an individual abstained from smoking and had an LDCT screen, the risk of dying of lung cancer decreased by 9%. For those individuals who abstained from smoking and had been screened with a chest x-ray, the risk of dying of lung cancer decreased by 3%.
In contrast, there was a 10% increase in lung cancer mortality for each additional 10 pack-years smoked for those screened with LDCT (HR, 1.10; 95% CI, 1.08-1.13). This “did not vary significantly in the chest radiograph group,” according to the researchers.
In both screening groups, “an additional 6% risk of death from all causes (was seen) for each additional 10 pack-years smoked.”
In addition, black study participants who had quit smoking at trial entry had “a more pronounced benefit” from having done so, compared with the white study participants (HR, 0.53, 95% CI, 0.28-1.0).
The NLST was sponsored by the National Cancer Institute. Dr. Nichole T. Tanner, one of this secondary analysis’s authors reported receiving grants from ACCP OneBreath Foundation for her work on this project and grants from Olympus America, Cook, and the American Cancer Society for other work. Disclosures for all investigators are available at atsjournals.org.
Smoking abstinence for 7 years results in a 20% reduction in death from lung cancer – a benefit that is comparable to three rounds of annual screening with low-dose helical computed tomography (LDCT) – in asymptomatic individuals with at least a 30–pack-year smoking history, based on a secondary analysis of 50,263 participants in the National Lung Screening Trial (NLST).
Not smoking for 7 years plus screening for lung cancer with LDCT conferred an additional 10% reduction in lung cancer mortality. Similar patterns for smoking cessation benefits were noted for overall mortality, as well.
“This study is the first to quantify the benefit of smoking cessation coupled with lung cancer screening in a cohort that is asymptomatic,” wrote Dr. Nichole T. Tanner of the Medical University of South Carolina, Charleston, and her colleagues (Am J Respir Crit Care. 2016 March 1. doi: 10.1164/rccm.201507-1420OC). “[Its] findings highlight the importance of integrating smoking cessation efforts into lung cancer screening programs.”
The NLST subset study included 47,902 participants who self-identified as non-Hispanic white and 2,361 who self-identified as non-Hispanic black; 24,190 were current smokers and 26,073 were former smokers who had quit within the 15 years prior to entering the study. Participants ranged in age from 55 to 74 years at the time of randomization and had a 30–pack-year or more history of cigarette smoking.
All participants were screened for lung cancer with either LDCT or a chest radiograph examination. A 20% reduction in death from lung cancer was seen in those who had abstained from smoking for 7 years and were screened for lung cancer with a chest radiograph and in those who had undergone three rounds of annual screening for lung cancer with LDCT and continued to smoke.
For former smokers screened with LDCT, the risk of dying of lung cancer decreased at a faster rate than it did for those screened with chest radiographs. For each additional year an individual abstained from smoking and had an LDCT screen, the risk of dying of lung cancer decreased by 9%. For those individuals who abstained from smoking and had been screened with a chest x-ray, the risk of dying of lung cancer decreased by 3%.
In contrast, there was a 10% increase in lung cancer mortality for each additional 10 pack-years smoked for those screened with LDCT (HR, 1.10; 95% CI, 1.08-1.13). This “did not vary significantly in the chest radiograph group,” according to the researchers.
In both screening groups, “an additional 6% risk of death from all causes (was seen) for each additional 10 pack-years smoked.”
In addition, black study participants who had quit smoking at trial entry had “a more pronounced benefit” from having done so, compared with the white study participants (HR, 0.53, 95% CI, 0.28-1.0).
The NLST was sponsored by the National Cancer Institute. Dr. Nichole T. Tanner, one of this secondary analysis’s authors reported receiving grants from ACCP OneBreath Foundation for her work on this project and grants from Olympus America, Cook, and the American Cancer Society for other work. Disclosures for all investigators are available at atsjournals.org.
FROM AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Key clinical point: Smoking cessation and lung cancer screening with low-dose helical computed tomography reduces lung cancer mortality.
Major finding: Combining 15 years of smoking cessation with LDCT screening for lung cancer resulted in a 38% risk reduction in lung cancer death.
Data source: A secondary analysis of a 50,263-person subset of the randomized, controlled National Lung Screening Trial.
Disclosures: The NLST was sponsored by the National Cancer Institute. Dr. Nichole T. Tanner, one of this secondary analysis’s authors reported receiving grants from ACCP OneBreath Foundation for her work on this project and grants from Olympus America, Cook, and the American Cancer Society for other work. Disclosures for all investigators are available at atsjournals.org.
Publicizing benefits of HPV vaccine may drive uptick in its use
Increased publicizing of the human papillomavirus (HPV) vaccine’s benefits could drive growth in patients’ usage of the vaccine, researchers said in a letter to the editors of the Pediatric Infectious Disease Journal.
Dr. Harry Pellman, clinical professor of pediatrics at the University of California, Irvine, and Brandon Brown, Ph.D., of the division of clinical sciences at the Center for Health Communities at the University of California, Riverside, cited having observed higher rates of HPV vaccinations in their practice, where doctors recommend the vaccine, than were found by a Centers for Disease Control and Prevention study (42% males, 60% females) as an explanation for their hypothesis. In Dr. Pellman’s and Dr. Brown’s study, which included 101 patients, 90% of male and 67% of female patients (P less than .01) received an HPV vaccination.
In an anonymous survey of these patients’ parents, the researchers learned that “strength of the provider recommendation” (85%) and “publicity around the importance of vaccinating against HPV disease” (69%) were the most common reasons parents chose to accept the HPV vaccination for their child. The pediatricians also noted that 89% of the parents surveyed who had a family member or friend diagnosed with cervical or female organ cancer agreed to have their child vaccinated.
Dr. Pellman and Dr. Brown also found that “wanting to learn more about the vaccine” (60%) was the reason given by most parents who opted not to have their child vaccinated to prevent HPV. “This also suggests that publicizing the role of HPV vaccination in preventing HPV disease and its consequences might be an important public health strategy,” they said.
To read the letter, go to (Pediatr Infect Dis J. 2016 Jan;35[1]:119-20 doi: 10.1097/INF.0000000000000941).
Increased publicizing of the human papillomavirus (HPV) vaccine’s benefits could drive growth in patients’ usage of the vaccine, researchers said in a letter to the editors of the Pediatric Infectious Disease Journal.
Dr. Harry Pellman, clinical professor of pediatrics at the University of California, Irvine, and Brandon Brown, Ph.D., of the division of clinical sciences at the Center for Health Communities at the University of California, Riverside, cited having observed higher rates of HPV vaccinations in their practice, where doctors recommend the vaccine, than were found by a Centers for Disease Control and Prevention study (42% males, 60% females) as an explanation for their hypothesis. In Dr. Pellman’s and Dr. Brown’s study, which included 101 patients, 90% of male and 67% of female patients (P less than .01) received an HPV vaccination.
In an anonymous survey of these patients’ parents, the researchers learned that “strength of the provider recommendation” (85%) and “publicity around the importance of vaccinating against HPV disease” (69%) were the most common reasons parents chose to accept the HPV vaccination for their child. The pediatricians also noted that 89% of the parents surveyed who had a family member or friend diagnosed with cervical or female organ cancer agreed to have their child vaccinated.
Dr. Pellman and Dr. Brown also found that “wanting to learn more about the vaccine” (60%) was the reason given by most parents who opted not to have their child vaccinated to prevent HPV. “This also suggests that publicizing the role of HPV vaccination in preventing HPV disease and its consequences might be an important public health strategy,” they said.
To read the letter, go to (Pediatr Infect Dis J. 2016 Jan;35[1]:119-20 doi: 10.1097/INF.0000000000000941).
Increased publicizing of the human papillomavirus (HPV) vaccine’s benefits could drive growth in patients’ usage of the vaccine, researchers said in a letter to the editors of the Pediatric Infectious Disease Journal.
Dr. Harry Pellman, clinical professor of pediatrics at the University of California, Irvine, and Brandon Brown, Ph.D., of the division of clinical sciences at the Center for Health Communities at the University of California, Riverside, cited having observed higher rates of HPV vaccinations in their practice, where doctors recommend the vaccine, than were found by a Centers for Disease Control and Prevention study (42% males, 60% females) as an explanation for their hypothesis. In Dr. Pellman’s and Dr. Brown’s study, which included 101 patients, 90% of male and 67% of female patients (P less than .01) received an HPV vaccination.
In an anonymous survey of these patients’ parents, the researchers learned that “strength of the provider recommendation” (85%) and “publicity around the importance of vaccinating against HPV disease” (69%) were the most common reasons parents chose to accept the HPV vaccination for their child. The pediatricians also noted that 89% of the parents surveyed who had a family member or friend diagnosed with cervical or female organ cancer agreed to have their child vaccinated.
Dr. Pellman and Dr. Brown also found that “wanting to learn more about the vaccine” (60%) was the reason given by most parents who opted not to have their child vaccinated to prevent HPV. “This also suggests that publicizing the role of HPV vaccination in preventing HPV disease and its consequences might be an important public health strategy,” they said.
To read the letter, go to (Pediatr Infect Dis J. 2016 Jan;35[1]:119-20 doi: 10.1097/INF.0000000000000941).
FROM THE PEDIATRIC INFECTIOUS DISEASE JOURNAL
WHO guidance for caring for pregnant women in Zika virus areas
The World Health Organization has released guidance for physicians and other healthcare providers on how to care for pregnant women in areas where Zika virus transmission is ongoing.
“The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission,” according to the document, released on March 2.
The WHO does not recommend testing all pregnant women in Zika endemic areas, but suggests that physicians consider offering a first-trimester ultrasound scan to all women presenting for antenatal care to accurately date the pregnancy and perform a basic fetal morphology assessment. Women should also be counseled to present early for treatment and diagnostic work-up if they develop any signs or symptoms of Zika virus infection, including conjunctivitis, joint pain, headache, muscle pain, and fatigue.
Pregnant women who have signs of infection or a history of Zika virus disease should be tested. The following steps can be taken to diagnose the disease:
• Using reverse transcription polymerase chain reaction in maternal serum within 5 days of onset of symptoms.
• Urine analysis within 3 weeks after the onset of symptoms.
• Saliva analysis.
• Serological tests with immunoglobulin M antibodies from the fifth day following onset of symptoms.
The WHO also recommends routinely performing investigations to exclude syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes.
Later in the pregnancy, all women should be offered an 18-20 week anomaly scan to identify, monitor, or exclude fetal brain abnormalities.
Any pregnant women with possible Zika virus and fetal microcephaly and/or brain abnormalities should be referred for specialized care.
The WHO’s recommendations were produced under the agency’s emergency procedures and will remain valid until August, at which time the Department of Reproductive Health and Research at WHO Geneva will renew or update them as appropriate.
The complete guidance is available here.
The World Health Organization has released guidance for physicians and other healthcare providers on how to care for pregnant women in areas where Zika virus transmission is ongoing.
“The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission,” according to the document, released on March 2.
The WHO does not recommend testing all pregnant women in Zika endemic areas, but suggests that physicians consider offering a first-trimester ultrasound scan to all women presenting for antenatal care to accurately date the pregnancy and perform a basic fetal morphology assessment. Women should also be counseled to present early for treatment and diagnostic work-up if they develop any signs or symptoms of Zika virus infection, including conjunctivitis, joint pain, headache, muscle pain, and fatigue.
Pregnant women who have signs of infection or a history of Zika virus disease should be tested. The following steps can be taken to diagnose the disease:
• Using reverse transcription polymerase chain reaction in maternal serum within 5 days of onset of symptoms.
• Urine analysis within 3 weeks after the onset of symptoms.
• Saliva analysis.
• Serological tests with immunoglobulin M antibodies from the fifth day following onset of symptoms.
The WHO also recommends routinely performing investigations to exclude syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes.
Later in the pregnancy, all women should be offered an 18-20 week anomaly scan to identify, monitor, or exclude fetal brain abnormalities.
Any pregnant women with possible Zika virus and fetal microcephaly and/or brain abnormalities should be referred for specialized care.
The WHO’s recommendations were produced under the agency’s emergency procedures and will remain valid until August, at which time the Department of Reproductive Health and Research at WHO Geneva will renew or update them as appropriate.
The complete guidance is available here.
The World Health Organization has released guidance for physicians and other healthcare providers on how to care for pregnant women in areas where Zika virus transmission is ongoing.
“The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission,” according to the document, released on March 2.
The WHO does not recommend testing all pregnant women in Zika endemic areas, but suggests that physicians consider offering a first-trimester ultrasound scan to all women presenting for antenatal care to accurately date the pregnancy and perform a basic fetal morphology assessment. Women should also be counseled to present early for treatment and diagnostic work-up if they develop any signs or symptoms of Zika virus infection, including conjunctivitis, joint pain, headache, muscle pain, and fatigue.
Pregnant women who have signs of infection or a history of Zika virus disease should be tested. The following steps can be taken to diagnose the disease:
• Using reverse transcription polymerase chain reaction in maternal serum within 5 days of onset of symptoms.
• Urine analysis within 3 weeks after the onset of symptoms.
• Saliva analysis.
• Serological tests with immunoglobulin M antibodies from the fifth day following onset of symptoms.
The WHO also recommends routinely performing investigations to exclude syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes.
Later in the pregnancy, all women should be offered an 18-20 week anomaly scan to identify, monitor, or exclude fetal brain abnormalities.
Any pregnant women with possible Zika virus and fetal microcephaly and/or brain abnormalities should be referred for specialized care.
The WHO’s recommendations were produced under the agency’s emergency procedures and will remain valid until August, at which time the Department of Reproductive Health and Research at WHO Geneva will renew or update them as appropriate.
The complete guidance is available here.
Study: 2.6% of patients discharged from U.S. hospital used probiotics
Probiotics were used by 2.6% of patients who had been discharged from 145 U.S. hospitals in 2012, according to an analysis of data by Sarah H. Yi of the Centers for Disease Control and Prevention and her colleagues.
“Whether probiotics are effective in preserving or restoring a healthy microbiome remains unknown, but the high prevalence of probiotic use among hospitalized patients may indicate a growing belief among clinicians that these agents may be an effective strategy for doing so,” Ms. Yi and her colleagues wrote.
The researchers used information contained in the Truven Health MarketScan Hospital Drug Database to estimate probiotic use in the inpatient setting.
Among 1,976,167 pediatric and adult patients discharged from 145 hospitals in 2012, 51,723 (2.6%) of the patients used probiotics. The individuals who used probiotics had been patients at 139 of the 145 hospitals. Compared with patients who had not used probiotics, the patients who had used probiotics were 21 times more likely to have a discharge diagnosis of Clostridium difficile infection (P less than .0001), almost 9 times more likely to have used antimicrobials (P less than .0001), more likely to have been admitted from another inpatient health care facility (P less than .0001), and more likely to have been transferred to another health care facility at discharge (P less than .001). Each of the probiotic formulations used contained between one and four organisms identified at the species level. Saccharomyces boulardii, Lactobacillus acidophilus, L. bulgaricus, and L. rhamnosus were the most commonly used probiotic formulations.
The top five diagnoses for the patients who received probiotics were septicemia (except in labor); pneumonia (except that caused by tuberculosis or sexually transmitted disease); intestinal infection; skin and subcutaneous tissue infections; and urinary tract infections. For those patients not taking probiotics, live-born infants, osteoarthritis, septicemia (except during labor), pneumonia (except that caused by tuberculosis or sexually transmitted disease), and heart failure (nonhypertensive) were the most commonly received diagnoses.
The researchers also analyzed a study of the use of probiotics at 60 hospitals during 2006-2012, which showed annual increases of probiotic use among discharged patients and an overall 2.9-fold increase in probiotic use during those years. Specifically, 10,722 discharged patients used probiotics in 2006, compared with 28,871 patients in 2012.
“Because the patients most likely to benefit [from probiotic use] are also most at risk for an adverse event, preclinical research focused on the selection of likely probiotics and carefully designed clinical trials with systematic assessment of safety is particularly important,” the researchers said.
Among the questions needed to addressed in future research on probiotic use is “which strain-specific organisms, which patient populations, at what doses, and in what time frames (related to antibiotic use in particular) are both safe and effective in the prevention or treatment of which diseases?” according to the researchers.
Read the study in American Journal of Infection Control (doi: 10.1016/j.ajic.2015.12.001).
Probiotics were used by 2.6% of patients who had been discharged from 145 U.S. hospitals in 2012, according to an analysis of data by Sarah H. Yi of the Centers for Disease Control and Prevention and her colleagues.
“Whether probiotics are effective in preserving or restoring a healthy microbiome remains unknown, but the high prevalence of probiotic use among hospitalized patients may indicate a growing belief among clinicians that these agents may be an effective strategy for doing so,” Ms. Yi and her colleagues wrote.
The researchers used information contained in the Truven Health MarketScan Hospital Drug Database to estimate probiotic use in the inpatient setting.
Among 1,976,167 pediatric and adult patients discharged from 145 hospitals in 2012, 51,723 (2.6%) of the patients used probiotics. The individuals who used probiotics had been patients at 139 of the 145 hospitals. Compared with patients who had not used probiotics, the patients who had used probiotics were 21 times more likely to have a discharge diagnosis of Clostridium difficile infection (P less than .0001), almost 9 times more likely to have used antimicrobials (P less than .0001), more likely to have been admitted from another inpatient health care facility (P less than .0001), and more likely to have been transferred to another health care facility at discharge (P less than .001). Each of the probiotic formulations used contained between one and four organisms identified at the species level. Saccharomyces boulardii, Lactobacillus acidophilus, L. bulgaricus, and L. rhamnosus were the most commonly used probiotic formulations.
The top five diagnoses for the patients who received probiotics were septicemia (except in labor); pneumonia (except that caused by tuberculosis or sexually transmitted disease); intestinal infection; skin and subcutaneous tissue infections; and urinary tract infections. For those patients not taking probiotics, live-born infants, osteoarthritis, septicemia (except during labor), pneumonia (except that caused by tuberculosis or sexually transmitted disease), and heart failure (nonhypertensive) were the most commonly received diagnoses.
The researchers also analyzed a study of the use of probiotics at 60 hospitals during 2006-2012, which showed annual increases of probiotic use among discharged patients and an overall 2.9-fold increase in probiotic use during those years. Specifically, 10,722 discharged patients used probiotics in 2006, compared with 28,871 patients in 2012.
“Because the patients most likely to benefit [from probiotic use] are also most at risk for an adverse event, preclinical research focused on the selection of likely probiotics and carefully designed clinical trials with systematic assessment of safety is particularly important,” the researchers said.
Among the questions needed to addressed in future research on probiotic use is “which strain-specific organisms, which patient populations, at what doses, and in what time frames (related to antibiotic use in particular) are both safe and effective in the prevention or treatment of which diseases?” according to the researchers.
Read the study in American Journal of Infection Control (doi: 10.1016/j.ajic.2015.12.001).
Probiotics were used by 2.6% of patients who had been discharged from 145 U.S. hospitals in 2012, according to an analysis of data by Sarah H. Yi of the Centers for Disease Control and Prevention and her colleagues.
“Whether probiotics are effective in preserving or restoring a healthy microbiome remains unknown, but the high prevalence of probiotic use among hospitalized patients may indicate a growing belief among clinicians that these agents may be an effective strategy for doing so,” Ms. Yi and her colleagues wrote.
The researchers used information contained in the Truven Health MarketScan Hospital Drug Database to estimate probiotic use in the inpatient setting.
Among 1,976,167 pediatric and adult patients discharged from 145 hospitals in 2012, 51,723 (2.6%) of the patients used probiotics. The individuals who used probiotics had been patients at 139 of the 145 hospitals. Compared with patients who had not used probiotics, the patients who had used probiotics were 21 times more likely to have a discharge diagnosis of Clostridium difficile infection (P less than .0001), almost 9 times more likely to have used antimicrobials (P less than .0001), more likely to have been admitted from another inpatient health care facility (P less than .0001), and more likely to have been transferred to another health care facility at discharge (P less than .001). Each of the probiotic formulations used contained between one and four organisms identified at the species level. Saccharomyces boulardii, Lactobacillus acidophilus, L. bulgaricus, and L. rhamnosus were the most commonly used probiotic formulations.
The top five diagnoses for the patients who received probiotics were septicemia (except in labor); pneumonia (except that caused by tuberculosis or sexually transmitted disease); intestinal infection; skin and subcutaneous tissue infections; and urinary tract infections. For those patients not taking probiotics, live-born infants, osteoarthritis, septicemia (except during labor), pneumonia (except that caused by tuberculosis or sexually transmitted disease), and heart failure (nonhypertensive) were the most commonly received diagnoses.
The researchers also analyzed a study of the use of probiotics at 60 hospitals during 2006-2012, which showed annual increases of probiotic use among discharged patients and an overall 2.9-fold increase in probiotic use during those years. Specifically, 10,722 discharged patients used probiotics in 2006, compared with 28,871 patients in 2012.
“Because the patients most likely to benefit [from probiotic use] are also most at risk for an adverse event, preclinical research focused on the selection of likely probiotics and carefully designed clinical trials with systematic assessment of safety is particularly important,” the researchers said.
Among the questions needed to addressed in future research on probiotic use is “which strain-specific organisms, which patient populations, at what doses, and in what time frames (related to antibiotic use in particular) are both safe and effective in the prevention or treatment of which diseases?” according to the researchers.
Read the study in American Journal of Infection Control (doi: 10.1016/j.ajic.2015.12.001).
FROM AMERICAN JOURNAL OF INFECTION CONTROL
Ebola continues to impact survivors as epidemic wanes
Ebola virus disease (EVD) survivors often complained of headache, musculoskeletal pain, and ocular symptoms during the weeks after they tested negative for the virus, according to an analysis of patients cared for at an Ebola treatment unit in Freetown, Sierra Leone.
The study participants included 44 EVD patients who were discharged from the treatment unit during December 2014 to March 2015 after testing negative for Ebola virus on separate days, in two consecutive negative polymerase chain reaction assessments. All 44 patients had attended at least two follow-up appointments at the treatment unit within 2 weeks of discharge, when the researchers conducted their analysis.
All survivors made at least one complaint about their health after discharge, with the median number of health issues and maximum number of health issues reported having been two and five, respectively. Of the 117 complaints reported by the patients, 31 were for musculoskeletal pain, 21 were for headaches, and 6 were for ocular problems, including eye pain, clear discharge, red eyes, and blurred vision.
While there were no significant differences in viral load at admission to the Ebola treatment unit between those patients who had ocular problems or musculoskeletal pain and those who did not, patients who reported headache had a significantly higher viral load at admission than those who did not report a headache.
Of the 44 EVD patients who had been discharged from the unit, one had died as of March 8, 2015. That patient’s death occurred 1 month after his recovery from acute EVD and was preceded by deteriorating respiratory symptoms and left-sided pleural effusion.
Dr. Janet T. Scott, a clinical lecturer in pharmacology and infectious disease at the Institute of Translational Medicine at the University of Liverpool (England), and her colleagues recommended future studies of Ebola survivors follow patients for a longer period of time than the first 2 weeks after discharge from an Ebola treatment center.
“Because some complications occur weeks or months after acute onset of EVD, some symptoms might be underestimated in this cohort,” the researchers said.
Read the study in Emerging Infectious Diseases (doi: 10.3201/eid2204.151302).
Ebola virus disease (EVD) survivors often complained of headache, musculoskeletal pain, and ocular symptoms during the weeks after they tested negative for the virus, according to an analysis of patients cared for at an Ebola treatment unit in Freetown, Sierra Leone.
The study participants included 44 EVD patients who were discharged from the treatment unit during December 2014 to March 2015 after testing negative for Ebola virus on separate days, in two consecutive negative polymerase chain reaction assessments. All 44 patients had attended at least two follow-up appointments at the treatment unit within 2 weeks of discharge, when the researchers conducted their analysis.
All survivors made at least one complaint about their health after discharge, with the median number of health issues and maximum number of health issues reported having been two and five, respectively. Of the 117 complaints reported by the patients, 31 were for musculoskeletal pain, 21 were for headaches, and 6 were for ocular problems, including eye pain, clear discharge, red eyes, and blurred vision.
While there were no significant differences in viral load at admission to the Ebola treatment unit between those patients who had ocular problems or musculoskeletal pain and those who did not, patients who reported headache had a significantly higher viral load at admission than those who did not report a headache.
Of the 44 EVD patients who had been discharged from the unit, one had died as of March 8, 2015. That patient’s death occurred 1 month after his recovery from acute EVD and was preceded by deteriorating respiratory symptoms and left-sided pleural effusion.
Dr. Janet T. Scott, a clinical lecturer in pharmacology and infectious disease at the Institute of Translational Medicine at the University of Liverpool (England), and her colleagues recommended future studies of Ebola survivors follow patients for a longer period of time than the first 2 weeks after discharge from an Ebola treatment center.
“Because some complications occur weeks or months after acute onset of EVD, some symptoms might be underestimated in this cohort,” the researchers said.
Read the study in Emerging Infectious Diseases (doi: 10.3201/eid2204.151302).
Ebola virus disease (EVD) survivors often complained of headache, musculoskeletal pain, and ocular symptoms during the weeks after they tested negative for the virus, according to an analysis of patients cared for at an Ebola treatment unit in Freetown, Sierra Leone.
The study participants included 44 EVD patients who were discharged from the treatment unit during December 2014 to March 2015 after testing negative for Ebola virus on separate days, in two consecutive negative polymerase chain reaction assessments. All 44 patients had attended at least two follow-up appointments at the treatment unit within 2 weeks of discharge, when the researchers conducted their analysis.
All survivors made at least one complaint about their health after discharge, with the median number of health issues and maximum number of health issues reported having been two and five, respectively. Of the 117 complaints reported by the patients, 31 were for musculoskeletal pain, 21 were for headaches, and 6 were for ocular problems, including eye pain, clear discharge, red eyes, and blurred vision.
While there were no significant differences in viral load at admission to the Ebola treatment unit between those patients who had ocular problems or musculoskeletal pain and those who did not, patients who reported headache had a significantly higher viral load at admission than those who did not report a headache.
Of the 44 EVD patients who had been discharged from the unit, one had died as of March 8, 2015. That patient’s death occurred 1 month after his recovery from acute EVD and was preceded by deteriorating respiratory symptoms and left-sided pleural effusion.
Dr. Janet T. Scott, a clinical lecturer in pharmacology and infectious disease at the Institute of Translational Medicine at the University of Liverpool (England), and her colleagues recommended future studies of Ebola survivors follow patients for a longer period of time than the first 2 weeks after discharge from an Ebola treatment center.
“Because some complications occur weeks or months after acute onset of EVD, some symptoms might be underestimated in this cohort,” the researchers said.
Read the study in Emerging Infectious Diseases (doi: 10.3201/eid2204.151302).
FROM EMERGING INFECTIOUS DISEASES
