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BACKGROUND: Clostridium difficile infection (CDI) causes significant morbidity and mortality rates, especially for patients in the intensive care unit (ICU). Data comparing trauma and surgery patients with CDI in the ICU with medical patients with CDI in the ICU are limited. METHODS: In a single-center study, we analyzed retrospective data from 25 trauma patients and 13 surgery patients aged 18 years or older who had CDI and had been admitted to the ICU. A comparison group of 156 medical patients aged 18 years or greater who had CDI and were admitted to the ICU also was identified. RESULTS: The trauma/surgery patients had a significantly higher mean number of ventilator days (13.5 ± 9.3 vs. 7.3 ± 7.2; p < 0.0004), Foley catheter days (11.9 ± 6.8 vs. 8.0 ± 7.9; p = 0.005), mean ICU length of stay (LOS) (12.34 ± 9.7 vs. 5.9 ± 5.9 days; p < 0.0003), and mean total LOS (16 ± 9.3 vs. 10.7 ± 8.4 days; p = 0.0008). However, the medical group had a significantly higher mean number of vasopressor days (2.07 ± 3.51) than the trauma/surgery group (0.58 ± 1.55; p < 0.0001). The overall survival rate was significantly higher in the trauma/surgery group than in the medical group (100% vs. 81%, respectively; p = 0.003). A higher percentage of patients in the trauma/surgery group received piperacillin/tazobactam before the diagnosis of CDI than the medical patients (58% vs. 37%, respectively; p = 0.02). The number of days that antibiotics were given prior to the development of CDI was greater in the trauma/surgery group than in the medical group (10.3 ± 6.7 vs. 7.6 ± 7.3 days; p = 0.04). Multiple logistic regression models determined ICU LOS (adjusted odds ratio [aOR] 1.27 days; 95% confidence interval [CI] 1.13-1.41), the presence of chronic obstructive pulmonary disease (COPD) (aOR 3.44; 95% CI 1.19-9.95), and piperacillin/tazobactam use (aOR 3.27; 95% CI 1.24-8.65) to be positively associated with CDI in the trauma/surgery group compared with the medical patients. CONCLUSIONS: Longer ICU stay, receipt of piperacillin/tazobactam, and having COPD were positively associated with CDI in trauma/surgery patients compared with medical patients. These findings suggest further consideration of the possibility of CDI should be given to patients admitted the surgical ICU for an extended period of time, receiving piperacillin/tazobactam, or having COPD. Additional evaluation of these factors in a larger patient sample is warranted.

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Clostridium difficile is the leading cause of hospital-acquired antibiotic-associated diarrhea worldwide; in addition, the proliferation of antibiotic-resistant C. difficile is becoming a significant problem. Virgin coconut oil (VCO) has been shown previously to have the antimicrobial activity. This study evaluates the lipid components of VCO for the control of C. difficile. VCO and its most active individual fatty acids were tested to evaluate their antimicrobial effect on C. difficile in vitro. The data indicate that exposure to lauric acid (C12) was the most inhibitory to growth (P<.001), as determined by a reduction in colony-forming units per milliliter. Capric acid (C10) and caprylic acid (C8) were inhibitory to growth, but to a lesser degree. VCO did not inhibit the growth of C. difficile; however, growth was inhibited when bacterial cells were exposed to 0.15-1.2% lipolyzed coconut oil. Transmission electron microscopy (TEM) showed the disruption of both the cell membrane and the cytoplasm of cells exposed to 2 mg/mL of lauric acid. Changes in bacterial cell membrane integrity were additionally confirmed for VCO and select fatty acids using Live/Dead staining. This study demonstrates the growth inhibition of C. difficile mediated by medium-chain fatty acids derived from VCO.

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BACKGROUND: The Ventriloscope® (Lecat's SimplySim, Tallmadge, OH) is a modified stethoscope used as a simulation training device for auscultation. OBJECTIVE: To test the effectiveness of the Ventriloscope as a training device in teaching heart and lung auscultatory findings to paramedic students. METHODS: A prospective, single-hospital study conducted in a paramedic-teaching program. The standard teaching group learned heart and lung sounds via audiocassette recordings and lecture, whereas the intervention group utilized the modified stethoscope in conjunction with patient volunteers. Study subjects took a pre-test, post-test, and a follow-up test to measure recognition of heart and lung sounds. RESULTS: The intervention group included 22 paramedic students and the standard group included 18 paramedic students. Pre-test scores did not differ using two-sample t-tests (standard group: t [16]=-1.63, p=0.12) and (intervention group: t [20]=-1.17, p=0.26). Improvement in pre-test to post-test scores was noted within each group (standard: t [17]=2.43, p=0.03; intervention: t [21]=4.81, p<0.0001). Follow-up scores for the standard group were not different from pre-test scores of 16.06 (t [17]=0.94, p=0.36). However, follow-up scores for the intervention group significantly improved from their respective pre-test score of 16.05 (t [21]=2.63, p=0.02). CONCLUSION: Simulation training using a modified stethoscope in conjunction with standardized patients allows for realistic learning of heart and lung sounds. This technique of simulation training achieved proficiency and better retention of heart and lung sounds in a safe teaching environment.

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RATIONALE, AIMS AND OBJECTIVES: Doctor compliance with diabetic care guidelines is low and may be improved with system-wide changes that include patient involvement. The objective of this study was to determine if patients in an internal medicine teaching clinic would use a touch-screen computer to receive personalized information regarding their need for diabetes care. Outcomes included determining if this intervention would improve resident doctor compliance with diabetic guidelines. METHODS: In this prospective study a computer was available for patients to use independently in one clinic, while another computer was placed in a second clinic with nursing support. Patients responding they were diabetic to the first screen received screens covering HbA1c, blood pressure, cholesterol, foot, eye examinations and compliance with having labs drawn. Non-diabetic patients received three general health screens. A response-based report was printed for patients to share with their doctor. Chart reviews were conducted to assess diabetic health care delivery. RESULTS: The computer was used voluntarily by 20.6% of patients in the primary clinic and by 100% of patients in the nurse-assisted clinic. A total of 104 patients from both clinics responded they were diabetic; over 50% did not know what HbA1c meant and a minority responded their HbA1c, blood pressure and cholesterol were at good levels. Significantly more HbA1c tests conducted within 6 months were documented in patients' charts. DISCUSSION: Patients used the computer effectively without direction in the primary clinic. In this initial study, implementation of the computer program increased the number of HbA1c tests ordered. Future studies incorporating refinements may increase both usage and efficacy of this intervention.

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RATIONALE AND OBJECTIVES: Renal tubular vacuolization (RTV), which has been shown to occur after the use of iodinated contrast material, may be one of the earliest signs of contrast medium-induced renal injury. In this study, the authors tested a method for preventing RTV with the administration of acetylcysteine, theophylline, or both, prior to contrast medium administration. MATERIALS AND METHODS: Eighty rats were randomly selected for inclusion in the study. The treatment group consisted of three subgroups, each of which received prophylactic acetylcysteine, theophylline, or both before injection of iohexol. The control group comprised five subgroups, each of which received acetylcysteine, theophylline, both, normal saline injection, or orally administered normal saline prior to iohexol injection. RESULTS: The occurrence of RTV in the treatment groups was compared with that in the control subgroup that received normal saline and iohexol. All of the rats in that control subgroup (n = 10) and 97% of the rats in the treatment group (n = 30) developed RTV. CONCLUSION: The administration of acetylcysteine, theophylline, or both prior to iohexol injection did not prevent RTV from occurring in rats.

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