Better Respiratory Education and Treatment Help Empower (BREATHE) study: Methodology and baseline characteristics of a randomized controlled trial testing a transitional care program to improve patient-centered care delivery among chronic obstructive pulmonary disease patients.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of hospitalizations. Interventional studies focusing on the hospital-to-home transition for COPD patients are few. In the BREATHE (Better Respiratory Education and Treatment Help Empower) study, we developed and tested a patient and family-centered transitional care program that helps prepare hospitalized COPD patients and their family caregivers to manage COPD at home. METHODS: In the study's initial phase, we co-developed the BREATHE transitional care program with COPD patients, family-caregivers, and stakeholders. The program offers tailored services to address individual patients' needs and priorities at the hospital and for 3months post discharge. We tested the program in a single-blinded RCT with 240 COPD patients who were randomized to receive the program or 'usual care'. Program participants were offered the opportunity to invite a family caregiver, if available, to enroll with them into the study. The primary outcomes were the combined number of COPD-related hospitalizations and Emergency Department (ED) visits per participant at 6months post discharge, and the change in health-related quality of life over the 6months study period. Other measures include 'all cause' hospitalizations and ED visits; patient activation; self-efficacy; and, self-care behaviors. DISCUSSION: Unlike 1month transitional care programs that focus on patients' post-acute care needs, the BREATHE program helps hospitalized COPD patients manage the post discharge period as well as prepare them for long term self-management of COPD. If proven effective, this program may offer a timely solution for hospitals in their attempts to reduce COPD rehospitalizations.

Thermal inactivation and injury of Moraxella-Acinetobacter cells in ground beef.

The thermal inactivation and injury (sensitivity to 0.8% NaCl) of a radiation-resistant culture of Moraxella-Acinetobacter mixed in minced beef were determined. Survival curves for Moraxella-Acinetobacter cells in beef had an initial shoulder preceding a logarithmic decline when the cells were heated at 65, 70, and 75 degrees C, but not at 80 degrees C. In all cases, the experimental points not included in the shoulder were linearized by means of a least-squares straight line, and the latter was used to determine D values. Shoulder values of 12.2, 4.1, and 0.6 min at temperatures of 65, 70, and 75 degrees C were added to the respective D values of 35.4, 6.6, and 1.4 min to determine the time required to destroy one log cycle. The Z value was 7.3 degrees C. Moraxella-Acinetobacter cells in meat were more rapidly injured than inactivated, on initial exposure to heat. The number of cells injured by this initial exposure increased as the temperature was increased. At 65 degrees C the percentage of injured cells increased more rapidly with exposure time than did the inactivated cells. As the temperature was increased, the rates of inactivation and injury became more and more similar.

Resuscitation of Stressed Fecal Coliforms and Their Subsequent Detection by Radiometric and Impedance Techniques.

Approximately 99% of cells in a heat-stressed Escherichia coli culture were injured and were able to grow on trypticase soy agar (TSA) but not on Violet Red Bile Agar (VRBA). Employing a surface-overlay or pour-overlay method, complete recovery of this thermally-stressed population required incubation of the TSA plates at 35 C for 6 h before overlaying with VRBA and incubating at 45 C. While the surface-overlay technique provides a more accurate index of injury than the pour-overlay method, there appears to be little difference in plating procedures with respect to recovery of injured cells. Heat-stressed cells were inactivated by the bile salts mixture in the conventional EC broth and by incubation temperatures of 42-45 C. Most of the heat-stressed cells were able to recover in 3 h at 35-37 C, without any evidence of replication, in EC broth minus the bile salts mixture (EC-B), adjusted to pH 6.1-6.5. Under similar conditions freeze-stressed cells recovered without multiplication within 1 h and the replication of an unstressed population of E. coli was evident in 2 h but not in 1 h of incubation. Both radiometry and impedance show promise as rapid (17-18 h) screening techniques for determining if a cooked food meets the microbial criterion of 0 fecal coliforms/g. A resuscitation period of 3 h was essential for reliable detection of thermally-stressed fecal coliforms by either radiometry or impedance. An impedance based-MPN procedure (18 h or less) compared favorably with a TSA/VRBA pour-overlay method (24 h) and a conventional 3-tube most probable number technique (48-72 h) for enumerating freeze-injured and uninjured fecal coliforms.

Cryogenic gamma irradiation of prototype pork and chicken and antagonistic effect between Clostridium botulinum types A and B.

Inoculated, irradiated pork (2,300 cans) and chicken (2,000 cans) pack studies were performed to establish the 12D dose for these foods. Each can was inoculated with a mixture of 10(6) spores of each of 10 strains of Clostridium botulinum (five type A and five type B), or a total of 10(7) spores. The cans received a series of increasing doses of gamma rays (60Co) at -30 +/- 10 degrees C; they were incubated for 6 months at 30 +/- 2 degrees C and examined for swelling, toxicity, and recoverable botulinal cells. The highest rate of swelling for both foods occurred within the first week of incubation, and maximum swelling was observed within 4 to 5 weeks. The minimal experimental sterilizing dose (ESD) based on flat, nontoxic sterile cans was 3.0 less than ESD less than or equal to 3.2 Mrad for pork and 4.0 less than ESD less than or equal to 4.2 Mrad for chicken. An analysis of the partial spoilage data by extreme-value statistics indicated with 90% confidence that the rate of spore death in the two foods was not a normal distribution, but appeared to favor a shifted exponential function. Based on the latter distribution, and assuming one most resistant strain in the mixture of 10 used, the 12D dose computed to 4.37 Mrad, with a shoulder of 0.11 Mrad, for pork and to 4.27 Mrad, with a shoulder of 0.51 Mrad, for chicken. An assumption that there were two or more most resistant strains in the inoculum progressively lowered the 12D dose. There was an apparent antagonism between the irradiated type A and B viable strains in the two foods. Cans with type B cells and toxin predominated over cans with type A cells and toxin, but cans with a mixture of type A and B toxins predominated over cans with a mixture of Type A and B cells. At the highest sublethal doses, only type A cells survived in pork, but in chicken there was a least one type B strain that was at least as resistant as type A strains.

Low-temperature irradiation of beef and methods of evaluation of radappertization process.

An inoculated, irradiated beef pack (1,240 cans) was conducted for the determination of microbiological safety for unrestricted human consumption. Each can contained a mixture of 10(6) spores of each of 10 strains of Clostridium botulinum (5 type A and 5 type B), or a total of 10(7) spores/can. The cans were irradiated to various doses (100 cans/dose) with 60Co gamma rays at -30 +/- 10 C, incubated at 30 +/- 2 C for 6 months, and examined for swelling, toxicity, and recoverable botulinal cells. The minimal experimental sterilizing dose based on nonswollen, nontoxic sterile cans were 2.2 less than experimental sterilizing dose based on nonswollen, nontoxic sterile cans was 2.2 less than experimental sterilizing dose less than or equal to 2.6 Mrad. Using recoverable cells as the most stringent criterion of spoilage, and assuming the conventional simple exponential (without an initial shoulder) rate of spore kill, the "12D" dose was 3.7 Mrad when estimated on the basis of mixture of 10 strains totaling 10(7) spores/can, and 4.3 Mrad if it is assumed that each can of beef contained 10(6) spores of a single most resistant strain and all of these spores were of identical resistances. However, an analysis of the data by extreme value statistics indicated with 90% confidence that the spore death rate was not a simple exponential but might be a shifted exponential (with an initial shoulder), Weibull, lognormal, or normal, with a "12D" equivalent of about 3.0 Mrad regardless of the initial spore density per can. There was an apparent antagonism between the irradiated type A and B strains in the cans. Some of the cans contained type B toxin but did not include type B viable cells. Other cans had a mixture of type A and B toxins, but a large number of these cans did not yield recoverable type B cells. However, type A viable cells could always be demonstrated in those cans containing type A toxin.