Does nonsteroidal anti-inflammatory drug use modify the effect of a low-fat, high-fiber diet on recurrence of colorectal adenomas?

The Polyp Prevention Trial was designed to evaluate the effects of a high-fiber (18 g/1,000 kcal), high-fruit and -vegetable (3.5 servings/1,000 kcal), low-fat (20% energy) diet on recurrence of adenomatous polyps. Participants > or =35 years of age, with histologically confirmed colorectal adenoma(s) removed in the prior 6 months, were randomized to the intervention or control group. Demographic, dietary, and clinical information, including use of nonsteroidal anti-inflammatory drugs (NSAID), was collected at baseline and four annual visits. Adenoma recurrence was found in 754 of 1,905 participants and was not significantly different between groups. NSAID use was associated with a significant reduction in recurrence [odds ratio (OR), 0.77; 95% confidence interval (95% CI), 0.63-0.95]. In this analysis, NSAIDs modified the association between the intervention and recurrence at baseline (P = 0.02) and throughout the trial (P = 0.008). Among participants who did not use NSAIDs, the intervention was in the protective direction but did not achieve statistical significance (OR, 0.87; 95% CI, 0.69-1.09). The intervention was protective among males who did not use NSAIDs at baseline (OR, 0.71; 95% CI, 0.54-0.94), but not among NSAIDs users (OR, 1.09; 95% CI, 0.74-1.62). For females, corresponding OR estimates were 1.28 (95% CI, 0.86-1.90) and 2.30 (95% CI, 1.24-4.27), respectively. The protective association observed for NSAID use was stronger among control (OR, 0.63; 95% CI, 0.47-0.84) than for intervention group participants (OR, 0.97; 95% CI, 0.74-1.28). These results should be interpreted cautiously given that they may have arisen by chance in the course of examining multiple associations and Polyp Prevention Trial study participants were not randomly assigned to both dietary intervention and NSAID use. Nevertheless, our results suggest that adopting a low-fat, high-fiber diet rich in fruits and vegetables may lower the risk of colorectal adenoma recurrence among individuals who do not regularly use NSAIDs.     

Interprofessional Education and Practice Guide No. 8: Team-based interprofessional practice placements

Whilst interest in interprofessional learning (IPL) in practice contexts has grown in recent years, the complexities involved have led many universities to rely on IPL in the classroom, online, and/or simulated contexts. Curtin University’s Faculty of Health Sciences has successfully implemented a multi-award winning, large-scale Interprofessional Practice Programme. This programme, which began with five small pilots in 2009, provides team-based interprofessional practice placements for over 550 students from nine professions per annum. Drawing on both the literature and Curtin University’s experience, this Interprofessional Education and Practice Guide aims to assist university and practice-based educators to “weigh the case” for introducing team-based interprofessional placements. The key lessons learned at Curtin University are identified to offer guidance to others towards establishing a similar programme for students during their prequalifying courses in health, social care, and related fields.     

Comparative anticoagulant activity and influence on thrombin generation of dextran derivatives and of a fucoidan fraction

CMDBS compounds are synthetic dextran derivatives with a random distribution of glucosyl units substituted with carboxymethyl, benzylamide, sulfonate, and sulfate groups. Fucoidans are sulfated polysaccharides extracted from brown seaweeds. CMDBS and fucoidans exhibit anticoagulant activity which depends on their chemical composition and molecular weight. Tested with purified proteins, these compounds catalyse thrombin (EC 3.4.21.5) inhibition mainly via heparin cofactor II (HCII). We investigated the mechanism involved in the anticoagulant activity of these polysaccharides relative to that of heparin. Three CMDBS with different chemical compositions were studied to evaluate the effect of sulfate and sulfonate groups on the anticoagulant activity. The fucoidan fraction was extracted from the brown seaweed Ascophylum nodosum. The clotting assays (activated partial thromboplastin time, thrombin time, prothrombin time) were significantly prolonged in the presence of CMDBS and fucoidan, which were less active than heparin. To investigate the action mechanism of these polysaccharides, thrombin generation tests (TGT) were performed on human plasma in the presence of several CMDBS and a fucoidan fraction. The results showed an inhibition of thrombin generation in contact-activated plasma in the presence of both polysaccharides, with a prolonged lag phase preceding the burst of thrombin generation. In thromboplastin-activated plasma, thrombin generation was inhibited by CMDBS and fucoidan, with a prolonged lag phase only in the presence of CMDBS. The data obtained with each polysaccharide, compared to those obtained with heparin (our study) and hirudin (published data), led to hypothesize that fucoidan could act, like heparin, by forming complexes with the inhibitor (although antithrombin (AT) in the case of heparin, and HCII for fucoidan), while CMDBS could act, like hirudin, by forming complexes with thrombin.