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2092 A multicenter study of fecal microbiota transplantation for Clostridium difficile infection in children
- Maribeth R. Nicholson, Erin Alexander, Mark Bartlett, Penny Becker, Zev Davidovics, Elizabeth E. Knackstedt, Michael Docktor, Michael Dole, Grace Felix, Jonathan Gisser, Suchitra Hourigan, Kyle Jensen, Jess Kaplan, Judith Kelsen, Melissa Kennedy, Sahil Khanna, McKenzie Leier, Jeffery Lewis, Ashley Lodarek, Sonia Michail, Paul Mitchell, Maria Oliva‐Hemker, Tiffany Patton, Karen Queliza, Namita Singh, Aliza Solomon, David Suskind, Steven Werlin, Richard Kellermayer, Stacy Kahn
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, p. 64
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- Article
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- Open access
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OBJECTIVES/SPECIFIC AIMS: Clostridium difficile infection (CDI) is the most common cause of antibiotic-associated diarrhea and an increasingly common infection in children in both hospital and community settings. Between 20% and 30% of pediatric patients will have a recurrence of symptoms in the days to weeks following an initial infection. Multiple recurrences have been successfully treated with fecal microbiota transplantation (FMT), though the body of evidence in pediatric patients is limited primarily to case reports and case series. The goal of our study was to better understand practices, success, and safety of FMT in children as well as identify risk factors associated with a failed FMT in our pediatric patients. METHODS/STUDY POPULATION: This multicenter retrospective analysis included 373 patients who underwent FMT for CDI between January 1, 2006 and January 1, 2017 from 18 pediatric centers. Demographics, baseline characteristics, FMT practices, C. difficile outcomes, and post-FMT complications were collected through chart abstraction. Successful FMT was defined as no recurrence of CDI within 60 days after FMT. Of the 373 patients in the cohort, 342 had known outcome data at two months post-FMT and were included in the primary analysis evaluating risk factors for recurrence post-FMT. An additional six patients who underwent FMT for refractory CDI were excluded from the primary analysis. Unadjusted analysis was performed using Wilcoxon rank-sum test, Pearson χ2 test, or Fisher exact test where appropriate. Stepwise logistic regression was utilized to determine independent predictors of success. RESULTS/ANTICIPATED RESULTS: The median age of included patients was 10 years (IQR; 3.0, 15.0) and 50% of patients were female. The majority of the cohort was White (89.0%). Comorbidities included 120 patients with inflammatory bowel disease (IBD) and 14 patients who had undergone a solid organ or stem cell transplantation. Of the 336 patients with known outcomes at two months, 272 (81%) had a successful outcome. In the 64 (19%) patients that did have a recurrence, 35 underwent repeat FMT which was successful in 20 of the 35 (57%). The overall success rate of FMT in preventing further episodes of CDI in the cohort with known outcome data was 87%. Unadjusted predictors of a primary FMT response are summarized. Based on stepwise logistic regression modeling, the use of fresh stool, FMT delivery via colonoscopy, the lack of a feeding tube, and a lower number of CDI episodes before undergoing FMT were independently associated with a successful outcome. There were 20 adverse events in the cohort assessed to be related to FMT, 6 of which were felt to be severe. There were no deaths assessed to be related to FMT in the cohort. DISCUSSION/SIGNIFICANCE OF IMPACT: The overall success of FMT in pediatric patients with recurrent or severe CDI is 81% after a single FMT. Children without a feeding tube, who receive an early FMT, FMT with fresh stool, or FMT via colonoscopy are less likely to have a recurrence of CDI in the 2 months following FMT. This is the first large study of FMT for CDI in a pediatric cohort. These findings, if confirmed by additional prospective studies, will support alterations in the practice of FMT in children.
“We never speak about death.” Healthcare professionals' views on palliative care for inpatients in Tanzania: A qualitative study
- E. Grace Lewis, Lloyd L. Oates, Jane Rogathi, Ashanti Duinmaijer, Aisa Shayo, Simon Megiroo, Barthlomew Bakari, Felicity Dewhurst, Richard W. Walker, Matt Dewhurst, Sarah Urasa
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- Journal:
- Palliative & Supportive Care / Volume 16 / Issue 5 / October 2018
- Published online by Cambridge University Press:
- 22 August 2017, pp. 566-579
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Objective:
Little is known about the current views and practices of healthcare professionals (HCPs) in Sub-Saharan Africa (SSA) regarding delivery of hospital palliative care. The present qualitative study explored the views of nursing staff and medical professionals on providing palliative and end-of-life care (EoLC) to hospital inpatients in Tanzania.
Method:Focus group discussions were conducted with a purposive sample of HCPs working on the medical and pediatric wards of the Kilimanjaro Christian Medical Centre, a tertiary referral hospital in northern Tanzania. Transcriptions were coded using a thematic approach.
Results:In total, 32 healthcare workers were interviewed via 7 focus group discussions and 1 semistructured interview. Four major themes were identified. First, HCPs held strong views on what factors were important to enable individuals with a life-limiting diagnosis to live and die well. Arriving at a state of “acceptance” was the ultimate goal; however, they acknowledged that they often fell short of achieving this for inpatients. Thus, the second theme involved identifying the “barriers” to delivering palliative care in hospital. Another important factor identified was difficulty with complex communications, particularly “breaking bad news,” the third theme. Fourth, participants were divided about their personal preferences for “place of EoLC,” but all emphasized the benefits of the hospital setting so as to enable better symptom control.
Significance of results:Despite the fact that all the HCPs interviewed were regularly involved in providing palliative and EoLC, they had received limited formal training in its provision, although they identified such training as a universal requirement. This training gap is likely to be present across much of SSA. Palliative care training, particularly in terms of communication skills, should be comprehensively integrated within undergraduate and postgraduate education. Research is needed to develop culturally appropriate curricula to equip HCPs to manage the complex communication challenges that occur in caring for a diverse inpatient group with palliative care needs.
Contributors
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- By Ashok Agarwal, Joseph P Alukal, Deborah J Anderson, Linda D Applegarth, Saleh Binsaleh, Elizabeth M Bloom, Karen E Boyle, Nancy L Brackett, Robert E Brannigan, James V Bruckner, Victor M Brugh, Ettore Caroppo, Grace M Centola, Aleksander Chudnovsky, Susan L Crockin, Fnu Deepinder, David M. Fenig, Aaron B Grotas, Matthew P. Hardy, Wayne J. G. Hellstrom, Stanton C Honig, Stuart S Howards, Keith Jarvi, Rajasingam S Jeyendran, William E Kaplan, Edward Karpman, Sanjay S Kasturi, Mohit Khera, Nancy A Klein, Dolores J Lamb, Jane M Lewis, Larry I Lipshultz, Kirk C Lo, Charles M Lynne, R. Dale McClure, Antoine A Makhlouf, Myles Margolis, Clara I. Marín-Briggiler, Randall B Meacham, Jesse N Mills, John P Mulhall, Alexander Müller, Christine Mullin, Harris M Nagler, Craig S Niederberger, Robert D Oates, Dana A Ohl, E. Charles Osterberg, Rodrigo L Pagani, Vassilios Papadopoulos, Joseph A Politch, Gail S Prins, Angela A Reese, Susan A Rothmann, Edmund S Sabanegh, Denny Sakkas, Jay I Sandlow, Richard A Schoor, Paulo C Serafini, Mark Sigman, Suresh C Sikka, Rebecca Z Sokol, Jens Sønksen, Miguel Srougi, James Stelling, Justin Tannir, Anthony J Thomas, Paul J Turek, Terry T Turner, Mónica H. Vazquez-Levin, Moshe Wald, Thomas J Walsh, Thomas M Wheeler, Daniel H Williams, Armand Zini, Barry R Zirkin
- Edited by Larry I. Lipshultz, Stuart S. Howards, University of Virginia, Craig S. Niederberger, University of Illinois, Chicago
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- Book:
- Infertility in the Male
- Published online:
- 19 May 2010
- Print publication:
- 24 September 2009, pp vii-x
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