The research article titled “Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case–control studies” by Dial et al. was published in the Canadian Medical Association Journal (CMAJ). The objective of this study was to investigate whether the proton pump inhibitors are an independent risk factor for Clostridium difficile-associated diarrhea. C. difficile is the most common cause of nosocomial infectious diarrhea. It is believed that antibiotic disruption of the normal intestinal flora, resulting in overgrowth of C. difficile and leading to this type of diarrhea. Some studies reported a possible association of C. difficile diarrhea and acid suppressive therapy. Since, the proton pump …show more content…
Both of the studies found similar results for the association, in spite of performing different study design, having different population and confounders; therefore the findings might be valid. But still there were some factors which could make the result biased. In the cohort study, all the required information of the participants was not available. So the result could be due to confounding. Therefore, the researchers performed a case-control study to assess and mitigate the possible selection bias and confounding. However, in the case-control study still had some selection bias and confounding effect. This study selected the sicker patients and more female patients as cases than control. This would make possibility of confounding in the observed results due to severity that the sicker patients are more susceptible to develop C. difficile diarrhea may also had a higher probability of receiving PPIs. The sicker patients are supervised more cautiously, so the chance of getting the outcome is more among them. The above mentioned points denote that further evaluation is needed to make any conclusion due to existing source of confounding though the results might not be
... clinical trial comparing two treatments is in progress, and a physician has an opinion about which treatment is better. This duty creates a barrier to the enrollment of patients in randomized clinical trials.
In a separate analysis we divided the patients to 2 groups, a group that used Proton pump inhibitor (omeprazole) and the control group; we found that out of 98 patients, 7 patients had PEP (5 sever, 1mild, 1 moderate) compared to 91patients that did not use PPI had 5 PEP. P value =0.7703
...n Article Nielsen et al (2013) Diagnostic Accuracy hierarchy methods is applied which is review on second level (II) i.e. Randomised Controlled Trial and Meta-Analysis in the Pyramid level. These are also considered as gold standard in hierarchy of research design for evaluating the safety of a treatment. Also therapeutic study method is applied where different patients of age groups are used to treat with two different temperatures. There are two different trial methods used in this study. Here the level of hierarchy is high so that we can trust the result based on the data provided. We can also provide and opportunities to collect useful information about adverse affect such as temperature control over cardiac arrest. In the Meta-Analysis method multiple treatment groups are been treated with each other. There is also observational study performed in the article.
A common hospital acquired condition that nurses see now days is clostridium difficile. This bacterium usually invades patients who have been on long-term antibiotics that have killed off bacteria that protect them from infection. C. diff is passed from host to host by both direct and indirect contact making it readily moved from patient to patient in hospital settings (Mayo, 2013, 1). Nurses can use the QSEN competencies and KSAs to help treat and prevent hospital acquired conditions such as C.diff.
As such techniques were not used in this study, I defined a recurrent urinary tract infection as the presence of 2 10,000 col/ml of a single bacteria and one or more urinary symptoms occurring at least two weeks after the initial infection. This may lead to some misclassification of outcome; however, as long as the classification is not associated with the exposure(s) of interest the resulting measures of association should be biased toward the null hypothesis of no difference. The associations between hypothesized risk factors and repeat UTI were studied using multilevel contingency tables, with both stratification and multivariate techniques to control for confounding.3 I calculated six-month cumulative incidences of UTI, risk ratios (RR), and Mantel-Haenszel summary RRs. Exact 95 percent confidence intervals (CI) were calculated around each RR using the method of Gart.4 A three-level symptoms scale, (0 = no hematuria or urgency, 1 = urgency alone, 2 = hematuria and urgency) was developed and used both as a dependent and
[According to a cohort participant,] cohorts are created not born. They are successful when everyone works collaboratively and collectively on improving their own and others' learning experiences. It takes self-responsibility, patience, courage, humor, commitment, sensitivity, and a lot of hard work to create such an enriching learning experience for everybody. (Nesbit 2001, p. 3)
When working with children it is vital we have a good understanding of the principles and values such as United Nations Children’s Rights Convention. The Foundation Phase curriculum promotes equality of opportunity and values, and celebrates diversity.’ (Foundation Phase revised curriculum, 2015) whereas the UNCRC focuses on the rights of the child, these rights underpins everything that practitioners do in the setting. Alternatively the Foundation Phase is a framework that is used to plan for children’s play and learning but gives us many opportunities to celebrate diversity and promote an inclusive and equal setting.
Omeprazole belongs to the family of medications called proton pump inhibitors (PPIs). It slows or prevents the production of acid within the stomach and is used to treat conditions where reduction in acid secretion is required for proper healing including stomach and intestinal ulcers (gastric and duodenal ulcers), the prevention and treatment of ulcers associated with medications known as NSAIDs, reflux oesophagitis, Zollinger-Ellison syndrome, heartburn, and gastro oesophageal reflux disease (GERD). Omeprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and oesophagus to heal. This essay will discuss the therapeutic effect and uses of Omeprazole, its mechanism of action, administration and dosage, dose-related and non-d...
In the statistical analysis the following findings showed: the intraclass correlation coefficient was 0.943 (CI 95%, 0.931-0.951); the Spearman correlation coefficient was 0.953 (CI 95%, 0.944-0.960); and the kappa statistic (0.863 0.72-0.934) (Glance, et al; 2010; pp729-731). It is important to note that underestimating the coding of comorbidities was understood and may have contributed to a bias toward the null hypotheses and maybe underestimate the
Ul-Haq, Z., Mackay, D. F., Fenwick, E., Pell, J. P. (2013). Meta-analysis of the association
Secondary:Curtis, L. (2008). Prevention of hospital-acquired infections: review of non-pharmacological interventions. Journal of Hospital Infection, 69(3), 204-219. Revised 01/20
Describe the differences in the results between the groups in the study and support your description with examples from the study
Among hospitalized patients around the world, Clostridium difficile is the primary source of infectious diarrhea. Previously, continuously unbalanced intestinal microbiota, usually due to antimicrobials, was deemed a precondition of developing the infection. However, recently, there have been alterations in the biology from virtually infecting the elderly population exclusively, wherein the microbiota in their guts have been interrupted by antimicrobials, to currently infecting individuals within of all age groups displaying no recent antimicrobial use. Furthermore, recent reports have confirmed critical occurrences among groups previously assumed to be of minimal risk—pregnant women, children, and individuals with no previous exposure to antimicrobials, for instance. Unfortunately, this Gram-positive, toxin-producing anaerobic bacterium is estimated to cost US critical care facilities $800 million per year at present, suggesting the need for effective measures to eliminate this nosocomial infection (Yakob, Riley, Paterson, & Clements, 2013).
Ageing population is a demographic problem that it is caused by the population which is getting older. The proportion of the different age groups is unbalanced that the phenomenon which are youngsters are fewer than elderly. It comes as no surprise, the health care system is being optimised, which provides better medical service, improving human life expectancy age. It is the biggest improvement in our world and the world is a better place to live in which demonstrate the success of human revolution. Nevertheless, the fertility has not risen as being a regardless issue. The social trend of the motivation of having children is declining. In addition, certain developed countries have legislated the one child policy that it accelerates the nightmare.
Gastroenteritis, sometimes referred to as infectious diarrhoea is a common disease that affects millions of people annually. It is a disease caused by viruses, bacteria or parasites that enter the human body and spread, which induce symptoms such as vomiting, diarrhoea, abdominal pain and nausea. Although it is a common occurrence in society and is usually not harmful, cases of gastroenteritis in less developed countries may have more fatal repercussions due to their inability to access ample means of treatment. Over time, as more research was conducted into the disease, scientific developments were made to aid those affected by gastroenteritis and reduce the number of fatalities by educating people regarding preventative methods.