EFFICACY OF TWICE-DAILY AMOXYCILLIN/CLAVULANATE (‘AUGMENTIN-DUO’ 400/57) IN MILD TO MODERATE LOWER RESPIRATORY TRACT INFECTION IN CHILDREN

SUMMARY A new amoxycillin/clavulanate regimen (‘Augmentin-Duo’ 400/57), to be given orally in two divided doses, has been proposed to overcome the inconvenience of tid dosing. This observer-blind, multicentre study randomised children aged two to 12 years with lower respiratory tract infection to seven days' treatment with either amoxycillin/clavulanate bid at a dose of 25/3.6mg/kg/day (221 patients) or the currently prescribed amoxycillin/clavulanate regimen of 20/5mg/kg/day tid (216 patients). Clinical success (cure) rates at follow up were 81.0% for the bid group and 77.8% for the tid group [difference 3.2%; 95% CI (-4.36, 10.80)], indicating that the regimens were of equivalent efficacy. Both regimens were well tolerated, and there was no statistically significant difference in the incidence of adverse experiences between the two groups. Compliance with study medication was high and similar for both groups (80% compliance: bid 90.0%; tid 87.0%).     

Aerosol propellant interference with clinical mass spectrometers

Metered dose inhalers containing halogenated propellants may interfere with mass spectrometer quantitation of halogenated inhalation anesthetics. We identify the propellant(s) in a commercially available metered dose inhaler that caused erroneous mass spectrometer readings. In addition, we identify the causes of different types of interference in different mass spectrometers.     

Cholecystokinin is a potent protective agent against alcohol-induced gastric injury in the rat

Cholecystokinin is a gastrointestinal hormone known to physiologically regulate pancreatic protein secretion and gallbladder contractility. Some evidence suggests that cholecystokinin is also involved in the maintenance of gastrointestinal mucosal integrity. This study was undertaken to ascertain whether cholecystokinin could prevent the gastric mucosal injury induced by acidified ethanol and what role prostaglandins, and type A and type B cholecystokinin receptors might play in this process. Conscious, fasted rats were given subcutaneous saline or cholecystokinin octapeptide (10–100 µg/kg) 30 min before a l-ml oral gastric bolus of acidified ethanol (150 mM HCl/50% ethanol). Five minutes later, rats were sacrificed and the total area of macroscopic injury quantitated (square millimeters). In additional experiments using a similar protocol, 1 ml of either the cyclooxygenase inhibitor, indomethacin (5 mg/kg), a type A cholecystokinin receptor antagonist, L-364,718 (0.01–1 mg/kg), or the type B cholecystokinin receptor antagonist, L-365,260 (12.5–25 mg/kg) was given intraperitoneally 30 min prior to pretreatment with cholecystokinin octapeptide. Cholecystokinin octapeptide dose-dependently prevented mucosal injury from acidified ethanol (corroborated by histology). The protective effect of cholecystokinin octapeptide was completely negated by L-364,718 and partially reversed by indomethacin, while L-365,260 had no discernible effect in this process. In a further study, cholecystokinin was unable to prevent the damaging effects of aspirin and the inhibition of endogenous prostaglandins. Thus, it appears that cholecystokinin is able to maintain mucosal integrity in the face of a damaging insult by activation of type A cholecystokinin receptors, an effect mediated, at least in part, through the release of endogenous prostaglandins.This work was supported by research grant DK 25838 awarded to Dr. Miller from the National Institutes of Health.     

Redefining and Redesigning Hospital Discharge to Enhance Patient Care: A Randomized Controlled Study

BACKGROUND  Patients are routinely ill-prepared for the transition from hospital to home. Inadequate communication between Hospitalists and primary care providers can further compromise post-discharge care. Redesigning the discharge process may improve the continuity and the quality of patient care. OBJECTIVES  To evaluate a low-cost intervention designed to promptly reconnect patients to their “medical home” after hospital discharge. DESIGN  Randomized controlled study. Intervention patients received a “user-friendly” Patient Discharge Form, and upon arrival at home, a telephone outreach from a nurse at their primary care site. PARTICIPANTS  A culturally and linguistically diverse group of patients admitted to a small community teaching hospital. MEASUREMENTS  Four undesirable outcomes were measured after hospital discharge: (1) no outpatient follow-up within 21 days; (2) readmission within 31 days; (3) emergency department visit within 31 days; and (4) failure by the primary care provider to complete an outpatient workup recommended by the hospital doctors. Outcomes of the intervention group were compared to concurrent and historical controls. RESULTS  Only 25.5% of intervention patients had 1 or more undesirable outcomes compared to 55.1% of the concurrent and 55.0% of the historical controls. Notably, only 14.9% of the intervention patients failed to follow-up within 21 days compared to 40.8% of the concurrent and 35.0% of the historical controls. Only 11.5% of recommended outpatient workups in the intervention group were incomplete versus 31.3% in the concurrent and 31.0% in the historical controls. CONCLUSIONS  A low-cost discharge–transfer intervention may improve the rates of outpatient follow-up and of completed workups after hospital discharge.     

Sensor technology implementation for research,treatment, and assessment of eating disorders

Sensor technology has made huge technological advances in the past decade. Many sensor technologies (e.g., wearable wristbands) have been integrated into health research with the ability to substantially improve health outcomes and reduce health care costs. Despite the rapid technological developments in sensor technology, little research has examined sensor technology in eating disorders (EDs). The overarching aim of the current article is to briefly review the literature on sensor technology and health outcomes, including EDs, and discuss several potential ideas for the application of sensor technology in the treatment, assessment, and diagnosis of EDs. We will also present data from a feasibility case study with an ED participant and healthy control providing a brief example of how wearable sensor technology might be implemented in ED research. Overall, we will discuss how sensor technology could be used to improve treatment and assessment of EDs and represents an idea in need of more research in the ED field.