Characteristics Associated With Clinically Important Treatment Responses in Women Undergoing Nonsurgical Therapy for Fecal Incontinence.

OBJECTIVE: To identify baseline clinical and demographic characteristics associated with clinically important treatment responses in a randomized trial of nonsurgical therapies for fecal incontinence (FI). METHODS: Women (N = 296) with FI were randomized to loperamide or placebo- and manometry-assisted biofeedback exercises or educational pamphlet in a 2 × 2 factorial design. Treatment response was defined in 3 ways from baseline to 24 weeks: minimal clinically important difference (MID) of -5 points in St. Mark's score, ≥50% reduction in FI episodes, and combined St. Mark's MID and ≥50% reduction FI episodes. Multivariable logistic regression models included baseline characteristics and treatment groups with and without controlling for drug and exercise adherence. RESULTS: Treatment response defined by St. Mark's MID was associated with higher symptom severity (adjusted odds ratio [aOR] 1.20, 95% confidence interval [CI] 1.11-1.28) and being overweight vs normal/underweight (aOR 2.15, 95% CI 1.07-4.34); these predictors remained controlling for adherence. Fifty percent reduction in FI episodes was associated with the combined loperamide/biofeedback group compared with placebo/pamphlet (aOR 4.04, 95% CI 1.36-11.98), St. Mark's score in the placebo/pamphlet group (aOR 1.29, 95% CI 1.01-1.65), FI subtype of urge vs urge plus passive FI (aOR 2.39, 95% CI 1.09-5.25), and passive vs urge plus passive FI (aOR 3.26, 95% CI 1.48-7.17). Controlling for adherence, associations remained, except St. Mark's score. DISCUSSION: Higher severity of FI symptoms, being overweight, drug adherence, FI subtype, and combined biofeedback and medication treatment were associated with clinically important treatment responses. This information may assist in counseling patients, regarding efficacy and expectations of nonsurgical treatments of FI.

Chemotherapeutic activity of levofloxacin (HR 355, DR-3355) against systemic and localized infections in laboratory animals.

Ofloxacin, its optical isomers levofloxacin (HR 355, DR-3355) and D-ofloxacin (DR-3354) and ciprofloxacin were administered orally to mice and rats which had systemic and localized infections. Both levofloxacin and ciprofloxacin were equally effective in treating systemic murine infections caused by staphylococci. Enterobacteriaceae or Pseudomonas aeruginosa with ED50s ranging from 0.18 to 15.8 mg/kg and 0.42 to 16.3 mg/kg respectively and both these agents were twice as effective as ofloxacin which had an ED50 0.41 to 39.7 mg/kg. In contrast, D-ofloxacin was either inactive or exhibited only modest chemotherapeutic activity against the staphylococci and the Gram-negative organisms tested. When given to mice to treat staphylococcal abscesses and lung infections due to Klebsiella pneumoniae DT-S levofloxacin was up to four times more effective and produced a more pronounced bactericidal effect against the pathogens in vivo than the reference compounds. Despite possessing a similar, if not lesser, in-vitro activity against the infecting pathogens, levofloxacin was more effective than ofloxacin and ciprofloxacin in rats with localized infections caused by Enterobacteriaceae and P. aeruginosa.

Alternate lunch patterns in high schools. IV. Nutritive value.

The nutritive value of lunches in forty-eight high schools was assessed using alternate methods of menu planning. Using Type A, Basic 4, and free-choice patterns, the nutrient levels in lunches consumed were not significantly different from those of lunches using the Type A "offer vs. serve" pattern. For boys, lunches as consumed were significantly below the goals for calories, thiamin, and iron in all groups. For girls, lunches as consumed were significantly below the goal only for iron.

Alternate lunch patterns in high schools. III. Food acceptability.

Food acceptability was assessed in forty-eight high schools using alternate methods of menu planning for school lunches. The free-choice pattern resulted in a significant reduction of total plate waste, particularly in the vegetable and salad categories. Girls consistently wasted more food than did boys, regardless of menu pattern. Overall plate waste was 7 and 13 per cent of food service for boys and girls, respectively. The data suggest that a free-choice lunch may be effective in reducing plate waste, particularly for poorly consumed menu items.

Alternate lunch patterns in high schools. I. Labor requirements and meal costs.

Meal costs were compared in forty-eight high schools as a function of the lunch pattern. The patterns evaluated were: Type A "offer vs. serve," traditional Type A, four food groups (Basic 4), and free choice. Participation in school lunch increased with free choice, resulting in a reduction in labor and total meal costs. Sixteen per cent of foodservice work involved administration, 37 per cent preparation, 16 per cent service, 25 per cent clean-up, and 6 per cent other, which did not vary with the menu pattern.