A survey of probiotic use practices among patients at a tertiary medical centre

2017 ◽  
Vol 8 (3) ◽  
pp. 345-351 ◽  
Author(s):  
K. Draper ◽  
C. Ley ◽  
J. Parsonnet
Keyword(s):  
Health Care Providers ◽  
Lactobacillus Rhamnosus ◽  
Antibiotic Use ◽  
Medical Centre ◽  
Supporting Evidence ◽  
Specific Recommendation ◽  
Care Providers ◽  
Electronic Survey ◽  
Probiotic Strains ◽  
Antibiotic Associated Diarrhoea

Probiotic use has skyrocketed in recent years. Little is known, however, about patient knowledge and practices regarding probiotic use, especially in the context of antibiotic use. An invitation to complete a short, anonymous, electronic survey was sent by email to 965 patients at a tertiary medical centre in California who had agreed to be contacted for participation in research studies. Questions were asked about both probiotic and antibiotic use in the prior three months. Of 333 survey respondents, 55% had recently used probiotics, including food products and/or supplements (90 and 60% of probiotic users, respectively). Women were more likely than men to have used probiotics (odds ratio (OR): 1.99; 95% confidence interval (CI): 1.2-3.4). Health care providers (HCP) had prescribed antibiotics to 79 (24%) respondents in the preceding three months. Among antibiotic users, 33% had initiated or changed probiotics at the time of antibiotic use, usually without a recommendation from their prescribing HCP (72%). Only 12% of those who took probiotics with antibiotics had received a specific recommendation from their HCP. Most patients chose to take probiotic mixtures (56%), with few selecting evidence-based strains, such as Lactobacillus rhamnosus GG (11%). Regular probiotic use among patients is common. Typically, these probiotics are not recommended by a HCP, even in conjunction with antibiotic prescriptions. While a growing body of evidence supports specific probiotic strains for the prevention of antibiotic-associated diarrhoea, patients are often not receiving a specific recommendation from their HCP and appear to be taking strains without guidance from supporting evidence.

scholarly journals Probiotics to reduce antibiotic administration in care home residents aged 65 years and older: the PRINCESS RCT

2021 ◽  
Vol 8 (7) ◽  
pp. 1-128
Author(s):  
Christopher C Butler ◽  
Eleri Owen-Jones ◽  
Mandy Lau ◽  
David Gillespie ◽  
Mark Lown ◽  
...  
Keyword(s):  
Care Home ◽  
Lactobacillus Rhamnosus ◽  
Antibiotic Use ◽  
Antibiotic Administration ◽  
Systemic Antibiotic ◽  
Bifidobacterium Animalis ◽  
Stool Samples ◽  
Future Work ◽  
Antibiotic Associated Diarrhoea

Background Care homes are an increasingly important sector of care. Care home residents are particularly vulnerable to infections and are often prescribed antibiotics, driving antibiotic resistance. Probiotics may be a cheap and safe way to reduce antibiotic use. Efficacy and possible mechanisms of action are yet to be rigorously evaluated in this group. Objective The objective was to evaluate efficacy and explore mechanisms of action of a daily oral probiotic combination in reducing antibiotic use and infections in care home residents. Design This was a multicentre, parallel, individually randomised, placebo-controlled, double-blind trial, with qualitative evaluation and mechanistic studies. Setting A total of 310 care home residents were randomised from 23 UK care homes (from December 2016 to May 2018). Participants The participants were care home residents aged ≥ 65 years who were willing and able to give informed consent or, if they lacked capacity to consent, had a consultee to advise about participation on their behalf. Intervention A daily capsule containing an oral probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12 (n = 155) or matched placebo (n = 155) for up to 1 year. Main outcome measures The primary outcome was cumulative systemic antibiotic administration days for all-cause infections. Secondary outcomes included incidence and duration of infections, antibiotic-associated diarrhoea, quality of life, hospitalisations and the detection of resistant Enterobacterales cultured from stool samples (not exclusively). Methods Participants were randomised (1 : 1) to receive capsules containing probiotic or matched placebo. Minimisation was implemented for recruiting care home and care home resident sex. Care home residents were followed up for 12 months with a review by a research nurse at 3 months and at 6–12 months post randomisation. Care home residents, consultees, care home staff and all members of the trial team, including assessors and statisticians, were blinded to group allocation. Results Care home residents who were randomised to probiotic had a mean 12.9 cumulative systemic antibiotic administration days (standard error 1.49 days) (n = 152) and care home residents randomised to placebo had a mean 12.0 cumulative systemic antibiotic administration days (standard error 1.50 days) (n = 153) (adjusted incidence rate ratio = 1.13, 95% confidence interval 0.79 to 1.63; p = 0.495). There was no evidence of any beneficial effects on incidence and duration of infections, antibiotic-associated diarrhoea, quality of life, hospitalisations, the detection of resistant Enterobacterales cultured from stool samples or other secondary outcomes. There was no evidence that this probiotic combination improved blood immune cell numbers, subtypes or responses to seasonal influenza vaccination. Conclusions Care home residents did not benefit from daily consumption of a combination of the probiotics Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12 to reduce antibiotic consumption. Limitations Limitations included the following: truncated follow-up of some participants; higher than expected probiotics in stool samples at baseline; fewer events than expected meant that study power may have been lower than anticipated; standard infection-related definitions were not used; and findings are not necessarily generalisable because effects may be strain specific and could vary according to patient population. Future work Future work could involve further rigorous efficacy, mechanisms and effectiveness trials of other probiotics in other population groups and settings regarding antibiotic use and susceptibility to and recovery from infections, in which potential harms should be carefully studied. Trial registration Current Controlled Trials ISRCTN16392920. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and NIHR partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 7. See the NIHR Journals Library website for further project information.

scholarly journals Mapping the Expert Mind: Integration Method for Revising the ACES Medical Simulation Curriculum

2020 ◽  
Vol 7 ◽  
pp. 238212052091327
Author(s):  
Pierre Cardinal ◽  
Glenn Barton ◽  
Kirk DesRosier ◽  
Sharon Yamashita ◽  
Angèle Landriault ◽  
...  
Keyword(s):  
Critically Ill ◽  
Health Care Providers ◽  
Educational Interventions ◽  
The Body ◽  
Critically Ill Patient ◽  
Critical Event ◽  
Supporting Evidence ◽  
Care Providers ◽  
Early Management ◽  
Knowledge Repository

Purpose: This article shares our experience developing an integrated curriculum for the ACES (Acute Critical Event Simulation) program. The purpose of the ACES program is to ensure that health care providers develop proficiency in the early management of critically ill patients. The program includes multiple different types of educational interventions (mostly simulation-based) and targets both specialty and family physicians practicing in tertiary and community hospitals. Methods: To facilitate integration between different educational interventions, we developed a knowledge repository consisting of cognitive sequence maps that make explicit the flow of cognitive activities carried out by experts facing different situations - the sequence maps then serving as the foundation upon which multimodal simulation scenarios would be built. To encourage participation of experts, we produced this repository as a peer-reviewed ebook. Five national organizations collaborated with the Royal College of Physicians and Surgeons of Canada to identify and recruit expert authors and reviewers. Foundational chapters, centered on goals/interventions, were first developed to comprehensively address most tasks conducted in the early management of a critically ill patient. Tasks from the foundational chapters were then used to complete the curriculum with situations. The curriculum development consisted of two-phases each followed by a peer-review process. In the first phase, focus groups using web-conferencing were conducted to map clinical practice approaches and in the second, authors completed the body of the chapter (e.g., introduction, definition, concepts, etc.) then provided a more detailed description of each task linked to supporting evidence. Results: Sixty-seven authors and thirty-five peer reviewers from various backgrounds (physicians, pharmacists, nurses, respiratory therapists) were recruited. On average, there were 32 tasks and 15 situations per chapter. The average number of focus group meetings needed to develop a map (one map per chapter) was 6.7 (SD ± 3.6). We found that the method greatly facilitated integration between different chapters especially for situations which are not limited to a single goal or intervention. For example, almost half of the tasks of the Hypercapnic Ventilatory Failure chapter map were borrowed from other maps with some modifications, which significantly reduced the authors’ workload and enhanced content integration. This chapter was also linked to 6 other chapters. Conclusions: To facilitate curriculum integration, we have developed a knowledge repository consisting of cognitive maps which organize time-sensitive tasks in the proper sequence; the repository serving as the foundation upon which other educational interventions are then built. While this methodology is demanding, authors welcomed the challenge given the scholarly value of their work, thus creating an interprofessional network of educators across Canada.

Canadian Clinical Practice Guidelines for Rosacea

2016 ◽  
Vol 20 (5) ◽  
pp. 432-445 ◽  
Author(s):  
Yuka Asai ◽  
Jerry Tan ◽  
Akerke Baibergenova ◽  
Benjamin Barankin ◽  
Chris L. Cochrane ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Cochrane Review ◽  
Ocular Involvement ◽  
Supporting Evidence ◽  
Care Providers ◽  
Facial Erythema ◽  
Inflammatory Dermatosis ◽  
Canadian Health ◽  
Clinical Trial Evidence

Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations. The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea. These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment. The 2015 Cochrane review “Interventions in Rosacea” was used as a source of clinical trial evidence on which to base the recommendations.

scholarly journals Do Interest Groups Cultivate Interest? Trajectories of Geriatric Interest Group Members

2020 ◽  
Vol 23 (3) ◽  
pp. 210-215
Author(s):  
Andrew Perrella ◽  
Ari B. Cuperfain ◽  
Amanda B. Canfield ◽  
Tricia Woo ◽  
Camilla L. Wong
Keyword(s):  
Older Adults ◽  
Interest Groups ◽  
Interest Group ◽  
Health Care Providers ◽  
Response Rate ◽  
Care Providers ◽  
Canadian Universities ◽  
Electronic Survey ◽  
Group Members ◽  
Ongoing Support

Background Minimal exposure, misconceptions, and lack of interest have historically driven the shortage of health-care providers for older adults. This study aimed to determine how medical stu­dents’ participation in the National Geriatrics Interest Group (NGIG) and local Geriatrics Interest Groups (GIGs) shapes their career development in the care of older adults. Methods An electronic survey consisting of quantitative and qualita­tive metrics to assess the influence of Interest Groups was distributed to all current and past members of local GIGs at Canadian universities since 2017, as well as current and past executives of the NGIG since 2011. Descriptive statistics and thematic analysis were performed. Results Thirty-one responses (27.7% response rate) were collected from medical students (13), residents (16), and physicians (2). 79% of resident respondents indicated they will likely have a geriatrics-focused medical practice. 45% of respondents indicated GIG/NGIG involvement facilitated the establish­ment of strong mentorship. Several themes emerged on how GIG/NGIG promoted interest in geriatrics: faculty mentor­ship, networking, dispelling stigma, and career advancement. Conclusion The positive associations with the development of geriatrics-focused careers and mentorship compel ongoing support for these organizations as a strategy to increase the number of physicians in geriatrics-related practices.

scholarly journals Surgical education at Weill Bugando Medical Centre: supplementing surgical training and investing in local health care providers

2013 ◽  
Vol 56 (3) ◽  
pp. 199-203 ◽  
Author(s):  
Katrina Mitchell ◽  
Geofrey Giiti ◽  
Vihar Kotecha ◽  
Alphonce Chandika ◽  
Kane Pryor ◽  
...  
Keyword(s):  
Health Care ◽  
Surgical Training ◽  
Health Care Providers ◽  
Surgical Education ◽  
Medical Centre ◽  
Local Health ◽  
Care Providers ◽  
Bugando Medical ◽  
Local Health Care ◽  
Bugando Medical Centre

Dynamics of Physicians’ Trust in Fellow Health Care Providers and the Role of Health Information Technology

2019 ◽  
pp. 107755871989234
Author(s):  
Minakshi Raj ◽  
Adam S. Wilk ◽  
Jodyn E. Platt
Keyword(s):  
Health Information ◽  
Health Care Providers ◽  
Information Technologies ◽  
Supporting Evidence ◽  
Care Providers ◽  
Health Information Technologies ◽  
Academic Center ◽  
Semistructured Interviews ◽  
Robust Measures

Physicians are expected and incentivized to coordinate patient care with other providers, including nonphysician clinician (NPC) members of care teams, requiring trust. Trust in the context of care teams has not been well-studied; even less is known about how health information technologies (HIT) may modify trust in these relationships. We conducted semistructured interviews with 30 physicians at a Midwestern academic center to examine how physicians determine they can trust NPCs, and how technology modifies these relationships. A majority of physicians base trust in NPCs on cognitive factors such as competence and reliability. Technology enhances trust between physicians and NPCs by supporting evidence-based decision making; it can also erode trust by limiting opportunities for developing familiarity and comfort with fellow providers. Our work has implications for enhancing HIT to promote trust between providers, and for developing more robust measures of trust that can be used in evaluating and improving teamwork within practices.

scholarly journals Knowledge and Attitudes Regarding Antibiotic Use Among Adult Consumers, Adult Hispanic Consumers, and Health Care Providers — United States, 2012–2013

2015 ◽  
Vol 64 (28) ◽  
pp. 767-770 ◽  
Author(s):  
Louise K. Francois Watkins ◽  
Guillermo V. Sanchez ◽  
Alison P. Albert ◽  
Rebecca M. Roberts ◽  
Lauri A. Hicks
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Providers ◽  
Antibiotic Use ◽  
Care Providers ◽  
Knowledge And Attitudes

scholarly journals Best-Evidence Rehabilitation for Chronic Pain Part 2: Pain during and after Cancer Treatment

2019 ◽  
Vol 8 (7) ◽  
pp. 979 ◽  
Author(s):  
An De Groef ◽  
Frauke Penen ◽  
Lore Dams ◽  
Elien Van der Gucht ◽  
Jo Nijs ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Health Care Providers ◽  
Exercise Therapy ◽  
Educational Interventions ◽  
Management Approach ◽  
Supporting Evidence ◽  
Care Providers ◽  
Breast Cancer Patients ◽  
General Exercise ◽  
After Cancer

Pain during, and especially after, cancer remains underestimated and undertreated. Moreover, both patients and health care providers are not aware of potential benefits of rehabilitation strategies for the management of pain during and following cancer treatment. In this paper, we firstly provided a state-of-the-art overview of the best evidence rehabilitation modalities for patients having (persistent) pain during and following cancer treatment, including educational interventions, specific exercise therapies, manual therapies, general exercise therapies and mind-body exercise therapies. Secondly, the findings were summarized from a clinical perspective and discussed from a scientific perspective. In conclusion, best evidence suggests that general exercise therapy has small pain-relieving effects. Supporting evidence for mind-body exercise therapy is available only in breast cancer patients. At this moment, there is a lack of high-quality evidence to support the use of specific exercises and manual therapy at the affected region for pain relief during and after cancer treatment. No clinically relevant results were found in favor of educational interventions restricted to a biomedical approach of pain. To increase available evidence these rehabilitation modalities should be applied according to, and within, a multidisciplinary biopsychosocial pain management approach. Larger, well-designed clinical trials tailored to the origin of pain and with proper evaluation of pain-related functioning and the patient’s pain experience are needed.

scholarly journals Pregnancy-related Pelvic Girdle Pain: Irish Physiotherapists’ Perspectives

2019 ◽  
Vol 3 (2) ◽  
pp. 01-05
Author(s):  
Sinéad Dufour
Keyword(s):  
Health Care Providers ◽  
Perinatal Period ◽  
Pelvic Girdle ◽  
Pelvic Girdle Pain ◽  
Care Providers ◽  
Important Conclusion ◽  
Electronic Survey ◽  
Private And Public ◽  
Survey Results ◽  
Psychosocial Influences

Background: Pregnancy-related pelvic girdle pain (PPGP) represents a common condition with implications for persistence. Currently, a practice gap appears to exist related to the assessment and management of pregnancy-related PGP. This study explored Irish physiotherapists’ perspectives of PPGP. Methods: A survey from previous Canadian research was adapted and used to determine Irish physiotherapist’s perspectives regarding PPGP. Women’s health physiotherapists, private and public sector, were invited to complete an electronic survey. Results: Sixty of the 122 invited physiotherapists completed the survey for a response rate of 49%. Of these, 98% agreed that relevant health care providers need to be able to recognize a PPGP presentation, and 80% believed PPGP to be a complex clinical presentation requiring early detection and associated care. The vast majority of perspectives related to etiology and treatment focused on musculoskeletal influences, however addressing fear (84%) and employing pain neuroscience education (82%) were also indicated to be very important. Conclusion: Pregnancy-related PGP is a distinct presentation of PGP impacting women in the perinatal period and beyond differs in etiology due to perinatal and associated bio psychosocial influences. Irish physiotherapists perceive a number of important evolving psychosocial characteristics of PPGP, however unsubstantiated strong perspectives related to biomechanics and pelvic stability were also found. Knowledge translation efforts to support the provision of evidence- informed care are needed.

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