Implementation of a Checklist to Reduce False-Positive Testing in Hospital-Acquired Clostridium Difficile Infection.

BACKGROUND: Clostridium difficile is a major pathogen responsible for nosocomial infectious diarrhea. After a spike in Clostridium difficile infection (CDI) cases, the focus team identified several cases of inappropriate sampling, i.e., asymptomatic patients being tested. We hypothesized that the inappropriate samples were leading to a high number of false-positive cases. We explored appropriate patient stool sampling as a strategy for reducing the number of asymptomatic cases in a 275-bed rural community hospital. METHODS: We conducted a prospective cohort study of inpatients to determine if appropriate stool sampling would result in a reduction in false positive Clostridium difficile cultures and decrease incidence of Clostridium difficile. We developed a checklist that would guide the nurse to improve the sampling process. RESULTS: The study implementation period ran from July through December 2016, with comparison to a control cohort in the prior six months. From Jan. 16 to May 15, the control group consisted of 461 inpatients, of which 89 tested positive for CDI 32.3 per 10,000 patient days. Of those 89 positive cases, 74 were identified as healthcare acquired infection (HAI) 26.8 per 10,000 patient days. Of these HAIs, 25 (33.8 percent) were inappropriate samples. In comparison, among the study period cohort of 277 inpatients, 46 inpatients tested positive for CDI 16.9 per 10,000 patient days, of which 26 were HAIs 9.5 per 10,000 patient days. During the study period, three samples (11.5 percent) were determined to be inappropriate. After the checklist implementation, the proportion of incorrect samples decreased from 33.8 percent to 11.5 percent. The number of HAI/patient days decreased form 0.024 percent to 0.08 percent. Similarly, the number of CDI/patient days also decreased from 0.295 percent to 0.15 percent. CONCLUSION: Implementation of a simple checklist prior to collection of stool sample proved to be effective in reducing the number of inappropriate samples sent for CDI testing, with a subsequent decrease in hospital acquired Clostridium difficile infections reported.

Sentence production in Parkinson's disease.

While growing evidence reports changes in language use in non-demented individuals with Parkinson's disease (PD), the presence and nature of the deficits remain largely unclear. Researchers have proposed that dysfunctioning fronto-basal ganglia circuit results in impaired grammatical processes, predicting qualitatively similar language impairments between individuals with PD and agrammatic Broca's aphasia, whereas others suggest that PD is not associated with language-specific grammatical impairment. In addition, there is a paucity of research examining syntactic production in PD at the sentence-level. This study examined sentence production of individuals with PD, healthy older adults, and individuals with agrammatic Broca's aphasia. In Experiment 1, using a Cinderella story-telling task, proportion of grammatical sentences, number of embedded clauses and production of verb arguments in sentences were examined. In Experiment 2, a structured sentence elicitation task was used in which syntactic complexity of sentences (canonical vs. non-canonical word order) was systematically manipulated while minimizing demands for non-syntactic processing. Only the participants with agrammatic Broca's aphasia showed significantly impaired syntactic production in both experiments. Participants with PD did not show impaired syntactic production in either task, despite impairments in lexical retrieval, repetition of words and sentences, and speech production. These findings suggest that impaired syntactic processing may not be a core deficit underlying the changes in language use in non-demented PD. Changes in language use in PD are qualitatively different from language deficits in aphasia.

Prevalence of thrombophilia and thrombotic events in patients with Fabry disease in a reference center for lysosomal disorders in Southern Brazil

Introduction: Venous thromboembolism (VTE) is a multifactorial genetic disorder that occurs in approximately one in a thousand adults per year. Because there is no laboratory test or clinical marker useful for predicting which patients with Fabry disease may develop thrombotic events, this study aimed to determine whether there is a hereditary predisposition to hypercoagulation in these patients. Methods: The prevalence of p.R506Q mutation in the factor V gene and of c.G20210A mutation in Factor II (prothrombin) gene was evaluated in 39 patients with Fabry disease from Southern Brazil and correlated with clinical findings. The DNA analysis was performed by real-time polymerase chain reaction on genomic DNA using TaqMan probes. Results: In this group of patients, the frequency of mutation in the prothrombin gene was 1.28%, whereas no patient showed mutation in the factor V gene; additionally, there was no correlation between these mutations and the incidence of thrombotic events. Conclusion: Hereditary thrombophilia due to mutations in factor V and prothrombin genes does not seem to be related to thrombotic events in Fabry patients in our cohort, although studies in larger cohorts and the inclusion of additional factors may be required to determine if a correlation exists.