Regulating complementary medicine. Statutory regulation is essential.
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Biomedical subjects
Publications and source records attributed to K D Phillips.
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This study examined the impact of a systematic nursing pain assessment tool (PAT) and pain flow sheet (PFS) on pain management. A control group (N = 23) was compared with a treatment group (N = 20) of hospitalized patients on a medical oncology unit. In the control group, "routine" charting of pain was done in the nurses' narrative notes. Patients in the treatment group underwent standardized pain assessment and documentation using a PAT and PFS. The treatment group reported significantly lower average pain intensity ratings (chi 2 = 5.019, p = 0.02) on day three of follow-up. In addition, a greater number of patients in the treatment group (85%) reported decreased pain intensity from day one to day three as compared with the control group (57%). This study supports other research and recommendations in the literature that use of systematic pain records can improve pain management.
Two enrichment methods were compared for their ability to recover Clostridium difficile from stool samples. One method used selective enrichment in an antibiotic-containing broth followed by detection with a latex particle agglutination (LPA) reagent. The other used enrichment in a non-selective broth following treatment of the specimen with alcohol. With clinical specimens enrichment culture was significantly more successful at detecting C. difficile than direct plating. Alcohol shock enrichment was twice as effective as direct culture, while selective broth enrichment was three times more effective. The use of LPA for screening selective enrichment broths for C. difficile should prove a cost-effective measure as only positive broths (about 20%) require subculture for confirmation.
Over a 2 1/2 year period 361 clinical isolates of clostridia, representing 28 species, were tested for susceptibility to commonly used antimicrobial agents. Penicillin resistant strains were tested for their ability to produce beta-lactamase: of the commonly isolated species only Clostridium beijerinckii/butyricum produced the enzyme. Cl. perfringens exhibited a low incidence of resistance to all of the agents tested. Cl. difficile showed a high degree of resistance to penicillin and clindamycin, whilst all strains were sensitive to vancomycin. Chloramphenicol and amoxycillin/clavulanic acid were found to be highly active against most clostridia; metronidazole was the only agent to which no resistance was demonstrable.
A modification of an existing selective medium for Clostridium difficile is described. Inclusion in the medium of DL nor-leucine and p-hydroxyphenylacetic acid enables identification of C difficile to be made directly from primary isolation plates by gas chromatographic detection of caproic acid and p-cresol. Plugs of agar withdrawn from the selective medium also allow the detection of cytotoxin production in vitro.
To assess the causative role of non-sporing anaerobes in cass of erosive balanoposthitis, anaerobic culture was performed on purulent discharges from 104 patients with penile ulceration, a foul-smelling discharge, and a mixed and motile bacterial flora. Most of 29 culturally confirmed infections were due to mixed anaerobes and eight to single anaerobes. A rapid response to treatment with metronidazole also confirmed the anaerobic cause of the infection. Thus, acute anaerobic balanoposthitis can be readily diagnosed clinically and is easily treated.
Three commercially available anaerobic cabinets are described and their performance in relation to one another and to a standard anaerobic jar technique are reported upon from a clinical laboratory.
A modification of a selective medium for Clostridium difficile is described. The ability of Cl difficile to produce p-cresol from p-hydroxy phenyl acetic acid provides a means for the rapid, sensitive detection and presumptive identification of this species in faecal cultures.
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A double-blind randomised trial was carried out among 46 patients undergoing elective colonic surgery; 27 patients received prophylactic metronidazole and 19 received placebo. Anaerobic infections did not develop in any of the metronidazole-treated patients, but did develop in 11 (58%) of 19 controls who were subsequently successfully treated with metronidazole.
The frequency of non-clostridial anaerobic infection was studied in 95 patients who had undergone acute appendicectomy: 49 received prophylactic metronidazole and 46 received placebo. Anaerobic infection did not develop in any of the metronidazole-treated patients, but infections did develop in nine (19%) of the 46 controls. Metronidazole is conveniently administered by suppository to patients who cannot take oral drugs. Five patients with intra-abdominal infections caused by non-clostridial anaerobes were successfully treated with metronidazole.
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Gas-liquid chromatographic analysis of samples of pus provides a rapid and reliable means for the presumptive differentiation of anaerobic from aerobic infections.