Assessment of Clostridium difficile Burden in Patients Over Time With First Episode Infection Following Fidaxomicin or Vancomycin

2015 ◽  
Vol 37 (2) ◽  
pp. 215-218 ◽  
Author(s):  
Seth T. Housman ◽  
Abrar K. Thabit ◽  
Joseph L. Kuti ◽  
Richard Quintiliani ◽  
David P. Nicolau
Keyword(s):  
Clostridium Difficile ◽  
Clinical Response ◽  
Infect Control Hosp ◽  
First Episode ◽  
Colony Forming Units ◽  
Over Time

In patients with first episode Clostridium difficile infection treated with vancomycin or fidaxomicin, more patients receiving fidaxomicin achieved at least 2 log10 colony-forming units/g reduction in spores at the follow-up visit (P=.02). Similar to published literature, a higher proportion of patients receiving fidaxomicin demonstrated sustained clinical response.Infect. Control Hosp. Epidemiol. 2016;37(2):215–218

scholarly journals Primary Outcomes From a Phase 3, Randomized, Double-Blind, Active-Controlled Trial of Surotomycin in Subjects With Clostridium difficile Infection

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Vicente Boix ◽  
Richard N. Fedorak ◽  
Kathleen M. Mullane ◽  
Yves Pesant ◽  
Uschi Stoutenburgh ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clinical Response ◽  
Clostridium Difficile Infection ◽  
Rank Test ◽  
Phase 3 ◽  
Double Blind ◽  
End Of Treatment ◽  
Secondary Endpoints ◽  
Over Time

Abstract Background Although the incidence of Clostridium difficile infection (CDI) is increasing, available CDI treatment options are limited in terms of sustained response after treatment. This phase 3 trial assessed the efficacy and safety of surotomycin, a novel bactericidal cyclic lipopeptide, versus oral vancomycin in subjects with CDI. Methods In this randomized, double-blind, active-controlled, multicenter, international trial, subjects with CDI confirmed by a positive toxin result were randomized to receive surotomycin (250 mg twice daily) or vancomycin (125 mg 4 times daily) orally for 10 days. The primary endpoints were clinical response at end of treatment and evaluation of surotomycin safety. The key secondary endpoints were clinical response over time and sustained clinical response through a 30- to 40-day follow-up period. Clostridium difficile infection recurrence during follow-up and time to diarrhea resolution were also analyzed. Results In total, 570 subjects were randomized and had confirmed CDI; 290 subjects received surotomycin and 280 subjects received vancomycin. Surotomycin clinical cure rates at end of treatment (surotomycin/vancomycin: 79.0%/83.6%; difference of −4.6%; 95% confidence interval, −11.0 to 1.9]), clinical response over time (stratified log-rank test, P = .832), and sustained clinical response at end of trial (Day 40–50) (60.6%/61.4%; difference of −0.8%; 95% CI, −8.8 to 7.1) in the microbiological modified intent to treat population did not meet noninferiority or superiority criteria versus vancomycin. Both treatments were generally well tolerated. Conclusions Surotomycin failed to meet the criteria for noninferiority versus vancomycin for the primary and key secondary endpoints in this trial.

scholarly journals S121. OPUS 20, 20 YEAR FOLLOW-UP ON THE OPUS TRIAL

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S81-S82
Author(s):  
Marie Starzer ◽  
Carsten Hjorthøj ◽  
Nikolai Albert ◽  
Merete Nordentoft ◽  
Helene Lund Sørensen
Keyword(s):  
Negative Symptoms ◽  
Participation Rate ◽  
First Episode ◽  
Episode Psychosis ◽  
Health Project ◽  
Gaf Scores ◽  
Positive And Negative Symptoms ◽  
Over Time

Abstract Background Since the first OPUS trial 20 years ago, structured clinical assessments have been collected from a cohort of first episode psychosis patients at 2, 5 and 10 years follow-up. They found that the symptomatology of patients clustered in distinct groups, and they were able to determine stable long-term trajectories of positive and negative symptoms. The Suffolk County Medical health project has followed patients after a first episode psychosis for 20 years. They also found a stable course of trajectories but with an overall significant worsening of symptom severity over time. The 20 year OPUS follow-up will give us the first opportunity to assess the long term outcome in a large representative cohort treated within modern mental health services with treatment available for all. Methods From 1998 to 2000 578 participants were randomized to OPUS or TAU. Baseline characteristics of the cohort were as follows: mean age 26.6 years, 59% were males, 66% had a diagnosis of schizophrenia and 27% had a secondary diagnosis of alcohol or substance abuse At the 20 year follow-up the investigators will be blinded to the original treatment allocation. The patients who wish to participate will be assessed using SAPS, SANS, SCAN, PSP and GAF. Socio-demographic factors and suicidal ideation will be register via self report. Cognitive function will be tested using BACS and all participants will be asked to fill out a number of self-rating questioners including WHO quality of life-BREF, self-perceived health, strengths and difficulties, the parenting scale and self-perceived negative symptoms. Using national Danish registers we can collect information on all former participants regarding the use of psychiatric and general healthcare services, medication, supported housing or homelessness, employment status, substance abuse and mortality. Results The OPUS 20 study started collecting data in Jan 2018. We are attempting to contact as many patients as possible from the 578 participants in the original OPUS cohort. At the time of writing we had included data and attempted contact to 322 participants. Overall 104 people (31,7%) have agreed to participate in the interviews. In the follow-up 10 years ago, the participation-rate was 60% so this is a big drop in participation rate. 41 (14%) have died, 31 (9,5%) were lost due to emigration, homelessness or hidden identity and/or disempowerment. 70 (21,3%) didn’t wish to participate and 76 (23,2%) never responded. Discussion Psychotic disorders and schizophrenia in particular are associated with progressive worsening of symptoms and profound social impairment, and as such are still very stigmatized. Results from the 10 year OPUS follow-up found stable trajectories of positive and negative symptoms over time, with a tendency of reduction and stabilization of positive symptoms but less variation of negative symptoms. They found poor but stable social functioning with a mean GAF score of 55 after 10 years. The Suffolk County mental health project also found stable trajectories of psychopathology measured with SAPS and SANS. They however found progressive worsening of GAF scores declining form 49 points at the beginning to 36 after 20 years. So far we have seen stable GAF scores and SAPS and SANS scores compared to OPUS 10. This gives rise to some optimism about the prognosis for schizophrenia compared to the findings of the Suffolk study. In our study the extensive interviews combined with the data collected form Danish registers give us a unique opportunity to look at the long term course of illness after FEP. The ability to test if previous findings are robust over time will be essential to the development of targeted interventions, differentiated to the needs of different patient groups.

scholarly journals Occipital nerve stimulation and deep brain stimulation for refractory cluster headache: a prospective analysis of efficacy over time

2020 ◽  
pp. 1-8
Author(s):  
Juan Ángel Aibar-Durán ◽  
María Jesús Álvarez Holzapfel ◽  
Rodrigo Rodríguez Rodríguez ◽  
Robert Belvis Nieto ◽  
Carles Roig Arnall ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Clinical Response ◽  
Brain Stimulation ◽  
Nerve Stimulation ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Over Time ◽  
Deep Brain

OBJECTIVEOccipital nerve stimulation (ONS) and deep brain stimulation (DBS) are widely used surgical treatments for chronic refractory cluster headache (CH). However, there is little literature regarding long-term follow-up of these treatments.METHODSThe authors describe two prospective cohorts of patients with refractory CH treated with ONS and DBS and compare preoperative to postoperative status at 6 and 12 months after the surgery and at final follow-up. Efficacy analysis using objective and subjective variables is reported, as well as medication reduction and complications.RESULTSThe ONS group consisted of 13 men and 4 women, with a median age of 44 years (range 31–61 years). The median number of attacks per week (NAw) before surgery was 28 (range 7–70), and the median follow-up duration was 48 months. The DBS group comprised 5 men and 2 women, with a median age of 50 years (range 29–64 years). The median NAw before surgery was 56 (range 14–140), and the median follow-up was 36 months. The NAw and visual analog scale score were significantly reduced for the ONS and DBS groups after surgery. However, while all the patients from the DBS group were considered responders at final follow-up, with more than 85% being satisfied with the treatment, approximately 29% of initial responders to ONS became resistant by the final follow-up (p = 0.0253).CONCLUSIONSONS is initially effective as a treatment for refractory CH, although a trend toward loss of efficacy was observed. No clear predictors of good clinical response were found in the present study. Conversely, DBS appears to be effective and provide a more stable clinical response over time with an acceptable rate of surgical complications.

scholarly journals Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies

2019 ◽  
Vol 50 (6) ◽  
pp. 991-1001 ◽  
Author(s):  
Olesya Ajnakina ◽  
Brendon Stubbs ◽  
Emma Francis ◽  
Fiona Gaughran ◽  
Anthony S. David ◽  
...  
Keyword(s):  
Systematic Review ◽  
Longitudinal Studies ◽  
Meta Analysis ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Hospitalised Patients ◽  
Episode Psychosis ◽  
Over Time

AbstractBackgroundReducing hospitalisation and length of stay (LOS) in hospital following first episode psychosis (FEP) is important, yet reliable measures of these outcomes and their moderators are lacking. We conducted a systematic review and meta-analysis to investigate the proportion of FEP cases who were hospitalised after their first contact with services and the LOS in a hospital during follow-up.MethodsStudies were identified from a systematic search across major electronic databases from inception to October 2017. Random effects meta-analyses and meta-regression analyses were conducted.Results81 longitudinal studies encompassing data for 23 280 FEP patients with an average follow-up length of 7 years were included. 55% (95% CI 50.3–60.5%) of FEP cases were hospitalised at least once during follow-up with the pooled average LOS of 116.7 days (95% CI 95.1–138.3). Older age of illness onset and being in a stable relationship were associated with a lower proportion of people who were hospitalised. While the proportion of hospitalised patients has not decreased over time, LOS has, with the sharpest reduction in the latest time period. The proportion of patients hospitalised during follow-up was highest in Australia and New Zealand (78.4%) compared to Europe (58.1%) and North America (48.0%); and lowest in Asia (32.5%). Black ethnicity and longer duration of untreated psychosis were associated with longer LOS; while less severe psychotic symptoms at baseline were associated with shorter LOS.ConclusionOne in two FEP cases required hospitalisation at least once during a 7-year follow-up with an average length of hospitalisation of 4 months during this period. LOS has declined over time, particularly in those countries in which it was previously longest.

Frequency of Contamination of Single-Patient-Use Nebulizers Over Time

2014 ◽  
Vol 35 (12) ◽  
pp. 1543-1546 ◽  
Author(s):  
David J. Weber ◽  
Maria F. Gergen ◽  
Emily E. Sickbert-Bennett ◽  
Kathleen A. Short ◽  
Kendra E. Lanza-Kaduce ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Hospitalized Patients ◽  
Infect Control Hosp ◽  
Single Patient ◽  
Colony Forming Units ◽  
Patient Use ◽  
Over Time

Adult hospitalized patients with cystic fibrosis commonly receive nebulized medications. For single-patient-use nebulizers that are cleaned after each use, there is infrequent nebulizer contamination (0%–11%) with only low numbers of epidemiologically important pathogens (less than 100 colony-forming units), and this contamination is similar after 24, 48, and 72 hours of use.Infect Control Hosp Epidemiol 2014;35(12):1553–1546

Longitudinal relationship between expressed emotion and cannabis misuse in young people with first-episode psychosis

2015 ◽  
Vol 30 (1) ◽  
pp. 20-25 ◽  
Author(s):  
C. González-Blanch ◽  
J.F. Gleeson ◽  
S.M. Cotton ◽  
K. Crisp ◽  
P.D. McGorry ◽  
...  
Keyword(s):  
Young People ◽  
Family Environment ◽  
Temporal Relationship ◽  
Expressed Emotion ◽  
First Episode Psychosis ◽  
First Episode ◽  
Episode Psychosis ◽  
Substance Involvement ◽  
Over Time

AbstractCarers’ expressed emotion (EE) and patients’ cannabis misuse are two of the most robust predictors of psychotic relapse. We aimed to examine the temporal relationship between EE and cannabis misuse. Sixty-three key carers of young people with first-episode psychosis (FEP) were assessed at baseline and 7-month follow-up. EE was measured in carers using the Family Questionnaire (FQ) and cannabis misuse in patients using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Correlational and hierarchical logistic regression analyses were conducted to examine the temporal relationship between EE components (i.e. criticism and emotional over involvement) and cannabis misuse. Carers’ criticism at baseline significantly predicted cannabis misuse according to the ASSIST at 7-month follow-up. The association remained significant after controlling for baseline symptom severity and social functioning (B = 0.15, P = .02). Conversely, baseline cannabis misuse was not associated with carers’ criticism at 7-month follow-up. Patients in families with high criticism showed a tendency to increase cannabis misuse over time whereas the opposite trend was observed in those with carers with low criticism. A family environment characterized by high criticism may become a key risk factor for worsening cannabis misuse over time in young people with FEP. Further studies should investigate the potential mechanisms (e.g., patient's anxiety or perceived stress) through which criticism increases cannabis misuse in FEP.

scholarly journals S115. EVALUATION OF THE CLINICAL UTILITY OF SYMPTOM DIMENSIONS ON LONG-TERM CLINICAL AND FUNCTIONAL OUTCOMES IN FIRST EPISODE PSYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S78-S78
Author(s):  
Ege Bor ◽  
Diego Quattrone ◽  
Victoria Rodriguez ◽  
Luis Alameda ◽  
Sinan Guloksuz ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Utility ◽  
Negative Symptoms ◽  
First Episode ◽  
Global Functioning ◽  
Symptom Dimensions ◽  
Episode Psychosis ◽  
Over Time

Abstract Background Current clinical utility of diagnostic categories in patients with psychosis is in debate. Alternatively, symptom-based dimensional approaches are suggested, but research on their utility and longitudinal stability is at its early phases, showing lack of consistencies. The aims of this prospective study are: 1) to test the stability of structure of symptom dimensions in first episode psychosis patients; 2) to explore the utility of symptom dimensions in predicting clinical and functional outcomes. Methods This study included a total of 208 with first episode of psychosis-spectrum disorders aged 18–65 years who presented to psychiatric services in South London, recruited as part of the Genetics and Psychosis Outcome (GAP) case-control study and EU-GEI multicentre case-control study. A subsample of 114 patients were traced after a mean of 6.5 years. Psychopathology was assessed at baseline and at follow-up using OPCRIT and tested with bifactor model, encompassing one general psychosis dimension and five specific symptom dimensions (positive, negative, disorganisation, mania, and depression). Follow up measures on functional outcome (assessed with GAF scale) and clinical outcomes (number and total length of hospitalisations) were derived from clinical records. Predictor role of baseline symptom dimensions was tested by multiple linear regression to predict global functioning; and by negative binomial regression for length of hospitalisation and number of hospital admissions. Results Factor loadings of disorganisation dimension were most likely to change longitudinally while loadings of positive dimension were most stable. Regarding dimension stability over time, all positive, disorganised and depressive symptoms significantly improved over time while manic and negative symptoms did not significantly differ. In terms of prediction of outcome, baseline manic symptoms were associated with reduced risk of hospitalisation (adj OR 1.56; 95% CI 1.01–2.38), reduced length of hospitalisation (adj IRR= 0.73; 95% CI 0.56–0.95) and better global functioning (β=5.21; 95% CI 2.46–7.95) at follow up. Similarly, depressive symptoms were associated with reduced length of hospitalisation (adj IRR= 0.77; CI 0.61–0.97). On the other hand, baseline positive symptoms were associated with increased risk of hospitalisation (adj OR 1.93; 95% CI 1.25–2.96). No other significant associations were found between the rest of symptom dimensions and outcomes. Discussion This study provides new evidence on the longitudinal stability of bifactor model of psychosis and, shows that all except manic and negative symptoms significantly improved over time. Whereas affective symptoms (including mania and depression) were associated with good prognosis, positive symptoms seem to predict poor clinical outcomes. The particular and different influence of affective and psychotic symptoms on long-term functional and clinical outcomes may have therapeutic implications and support the potential clinical utility of incorporating symptom-based approach in further outcome research.

The trajectory of cognitive functioning following first episode mania: A 12-month follow-up study

2016 ◽  
Vol 50 (12) ◽  
pp. 1186-1197 ◽  
Author(s):  
Rothanthi Daglas ◽  
Kelly Allott ◽  
Murat Yücel ◽  
Christos Pantelis ◽  
Craig A. Macneil ◽  
...  
Keyword(s):  
Cognitive Functioning ◽  
Processing Speed ◽  
Verbal Learning ◽  
Cognitive Change ◽  
First Episode ◽  
Healthy Controls ◽  
Significant Group ◽  
Time Interaction ◽  
Over Time

Objectives: Cognitive deficits are apparent in the early stages of bipolar disorder; however, the timing and trajectory of cognitive functioning following a first episode of mania remains unclear. The aim of this study was to assess the trajectory of cognitive functioning in people following a first episode of mania over a 12-month period, relative to healthy controls. Method: The cohort included 61 participants who had recently stabilised from a first treated manic episode, and 21 demographically similar healthy controls. These groups were compared on changes observed over time using an extensive cognitive battery, over a 12-month follow-up period. Results: A significant group by time interaction was observed in one measure of processing speed (Trail Making Test – part A,) and immediate verbal memory (Rey Auditory Verbal Learning Test – trial 1), with an improved performance in people following a first episode of mania relative to healthy controls. On the contrary, there was a significant group by time interaction observed on another processing speed task pertaining to focussed reaction time (Go/No-Go, missed go responses), with first episode of mania participants performing significantly slower in comparison with healthy controls. Furthermore, a significant group by time interaction was observed in inhibitory effortful control (Stroop effect), in which healthy controls showed an improvement over time relative to first episode of mania participants. There were no other significant interactions of group by time related to other measures of cognition over the 12-month period. Conclusion: Our findings revealed cognitive change in processing speed, immediate memory and one measure of executive functioning over a 12-month period in first episode of mania participants relative to healthy controls. There was no evidence of change over time for all other cognitive domains. Further studies focussed on the at-risk period, subgroup analysis, and the effects of medication on the cognitive trajectory following first episode of mania are needed.

scholarly journals Patterns of Functional Impairment over Time Amongst Older Men—the Manitoba Follow-up StudyY

2021 ◽  
Vol 24 (2) ◽  
pp. 144-150
Author(s):  
Philip D. St John ◽  
Audrey U. Swift ◽  
Robert B. Tate
Keyword(s):  
Functional Status ◽  
Daily Living ◽  
Older Men ◽  
Considerable Change ◽  
First Episode ◽  
Present Survey ◽  
Follow Up Study ◽  
Recurrent Patterns ◽  
Over Time

Background To determine the incidence and prevalence patterns of activity of daily living (ADL) impairments in ageing men. Methods 3,983 men were enrolled in the Manitoba Follow-up Study (MFUS) cohort study in 1948. From 1996 onwards, functional status was measured. We classified basic (BADL) and instru­mental (IADL) into mutually exclusive categories as a time dependant factor after the second survey wave as: First survey response; no limitation; incident (first episode of disability); persistent (limitation which was seen on all questionnaires after the incident episode); resilient (noted in previous surveys but not present); and recurrent (noted in present survey, and limitations noted as present and absent in previous surveys). Results There were 1,745 participants in 1996 at a mean age of 76 years. Incident BADL limitations increased substantially with age: from 1% at age 75 to 15% at age 95. Similarly, persistent limitations increased with age: from 0.4% at age 75 to 18% at age 95. However, BADL function was fluid, with many in­dividuals grouped within the resilient and recurrent patterns. Similar age effects and variability were noted in IADLs. Conclusion New and persistent disabilities are highly associated with age. However, there is considerable change in functional status over time.

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