Coating urinary catheters with an avirulent strain of Escherichia coli as a means to establish asymptomatic colonization.

We investigated whether insertion of urinary catheters that had been coated with Escherichia coli HU2117 could establish bladder colonization with this nonvirulent organism. Ten of 12 subjects were successfully colonized for 14 days or more. The rate of symptomatic UTI during colonization was 0.15 per 100 patient-days.

Are patient ratings of chronic pain services related to treatment outcome?

Consumer ratings of satisfaction with treatment are rarely used as measures of treatment outcome. This study examined the relationships between service ratings and psychometric outcomes of patients receiving pain-management services in a tertiary teaching hospital. A group of 122 patients who completed a multidisciplinary pain-management program rated their satisfaction with and effectiveness of services received and changes in their pain condition and quality of life (QOL). They also completed pre- and posttreatment measures of pain severity, pain interference, depression, and disability. Pain severity, pain interference, and depression significantly decreased following treatment. The patients' ratings of services were significantly associated with outcome measures. Pre- to posttreatment changes in pain severity and pain interference were associated with treatment satisfaction and effectiveness, improvement in pain condition, and QOL. Pre- to posttreatment change in disability was significantly related to ratings of treatment effectiveness, improvement in pain condition, and quality of life. The findings suggest that pain intensity, pain interference, and disability are important outcome dimensions of pain-management programs.

Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury.

Treatments for chronic pain in persons with spinal cord injury (SCI) have been less than effective. Cranial electrotherapy stimulation (CES), a noninvasive technique that delivers a microcurrent to the brain via ear clip electrodes, has been shown to effectively treat several neurological and psychiatric disorders. The present study examined the effects of daily 1-hour active CES or sham CES treatment (randomly assigned) for 21 days on pain intensity and interference with activities in 38 males with SCI. The active CES group (n = 18) reported significantly decreased daily pain intensity compared with the sham CES group (n = 20) (mean change: active CES = -0.73, sham CES = -0.08; p = 0.03). Additionally, the active CES group reported significantly decreased pain interference (-14.6 pre- vs postintervention, p = 0.004) in contrast to the nonsignificant decrease in the sham CES group (-4.7 pre- vs postintervention, p = 0.24). These results suggest that CES can effectively treat chronic pain in persons with SCI.

Mortality risk factors in chronic haemodialysis patients with infective endocarditis.

BACKGROUND: It is well documented that infective endocarditis (IE) is strongly associated with morbidity and mortality in haemodialysis (HD) patients. Less clear are the mortality risk factors for IE, particularly in an urban African-American dialysis population. METHODS: IE patients were identified from the medical records for the period from January 1999 to February 2004 and confirmed by Duke criteria. The patients were classified as 'survivors' and 'non-survivors' depending on in-hospital mortality, and risk factors for IE mortality were determined by comparing the two cohorts. Survivors were followed as out-patients with death as the endpoint. RESULTS: A total of 52 patients with 54 episodes of IE were identified. A catheter was the HD access in 40 patients (74%). Mitral valve (50%) was the commonest valve involved, and Gram-positive infections accounted for 87% of IE. In-hospital mortality was high (37%) and valve replacement was required for 13 IE episodes (24%). On logistic regression analyses, mitral valve disease [P = 0.002; odds ratio (OR) = 15.04; 95% confidence interval (CI) = 2.70-83.61] and septic embolism (P = 0.0099; OR = 9.56; 95% CI = 1.72-53.21) were significantly associated with in-hospital mortality. Using the Cox proportional hazards model, mitral valve involvement (P = 0.0008; hazard ratio 4.05; 95% CI = 1.78-9.21) and IE related to drug-resistant organisms such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus sp. (P = 0.016; hazard ratio 2.43; 95% CI = 1.18-5.00) were associated with poor outcome after hospital discharge. CONCLUSIONS: IE was associated with high mortality in our predominantly African-American dialysis population, when the mitral valve was involved, or septic emboli occurred and if MRSA or VRE were the causal organisms.

Bacterial interference for prevention of urinary tract infection: a prospective, randomized, placebo-controlled, double-blind pilot trial.

This prospective, randomized, placebo-controlled, double-blind pilot trial examined the efficacy of bacterial interference in preventing urinary tract infection (UTI) in 27 patients with spinal cord injury. Patients whose bladders became colonized with Escherichia coli 83972 were half as likely (P=.01) than noncolonized patients to develop UTI during the subsequent year.

Validation of the Brief Pain Inventory for chronic nonmalignant pain.

UNLABELLED: The Brief Pain Inventory (BPI; Cleeland and associates) has been used primarily to assess patients with cancer-related pain. Although it has been validated in many languages and is widely used, there has not yet been research published to validate its use for patients with chronic nonmalignant pain as the primary presenting problem. This study was designed to fill this gap by examining the psychometric properties of the BPI in 440 patients with chronic intractable pain referred to a chronic pain clinic at a metropolitan tertiary-care teaching hospital. Results indicated acceptable internal consistency (Cronbach alpha coefficients were.85 for the intensity items and.88 for the interference items). A factor analysis resulted in 2 distinct and independent factors, supporting the validity of the 2-factor structure of the BPI. Zero-order correlations indicated that the association with a measure of disability (the Roland-Morris Disability Questionnaire [RMDQ]) was significantly higher for BPI interference (r = 0.57) than for BPI intensity (r = 0.40, t = 5.71, P <.01) and that the correlation with BPI interference was not more than 0.80, supporting the conclusion that these scales assess related, but also distinct, dimensions. Finally, the finding that both BPI scales showed statistically significant improvement with treatment confirms the responsivity of BPI in detecting and reflecting improvement in pain over time. PERSPECTIVE: This paper validated the psychometric properties of a pain Assessment instrument (The Brief Pain Inventory) originally developed to assess cancer pain and extended its use for the chronic nonmalignant pain population. This provides an important and widely used diagnostic tool for the clinician treating chronic pain.

Measuring control appraisals in chronic pain.

Research has established a positive association between appraisals of control over pain and indexes of adaptive psychologic and physical functioning among persons with chronic pain. A number of measures of control appraisals have been used in the research literature. The current study sought to determine the number of factors or dimensions embedded in these commonly used measures of pain control appraisal. The study also sought to determine the association between the control appraisal construct(s) and measures of patient functioning. Two hundred fifty-two persons with chronic pain completed a questionnaire packet that included multiple measures of control appraisals. A factor analysis resulted in 6 factors: 1 factor representing beliefs about control over life in general, 1 representing perceived control over the effects of pain on one's life, and remaining 4 factors that appear to be more closely tied to perceived control over pain itself. Consistent with previous research, control appraisals made a significant contribution to the prediction of functioning (depression, disability, and pain interference). Most importantly, perceived control over the effects of pain on one's life and perceived control over life in general were more strongly associated with functioning than perceptions of control over pain itself.

Pre-inoculation of urinary catheters with Escherichia coli 83972 inhibits catheter colonization by Enterococcus faecalis.

PURPOSE: The capacity of a preexisting coating of Escherichia coli 83972 to reduce catheter colonization by Enterococcus faecalis 210 was investigated. Enterococcus was chosen for these trials since it is a common urinary pathogen in patients with an indwelling urinary catheter. MATERIALS AND METHODS: Each experiment tested 3 growth conditions. Group 1 or E. coli plus Enterococcus catheters were exposed to E. coli 83972 for 24 hours and then to Enterococcus for 30 minutes. Group 2 or E. coli alone catheters were incubated in E. coli for 24 hours and then in sterile broth for 30 minutes. Group 3 or Enterococcus alone catheters did not undergo the initial incubation with E. coli before the 30-minute incubation with Enterococcus: All catheters were then incubated in sterile human urine for 24 hours. Catheters were washed with saline and cut into 5, 1 cm. segments. Each segment was sonicated and the sonication fluid was diluted and plated. The results of each of the 5 segments were averaged and the set of experiments was repeated 7 times. RESULTS: A preexisting coating of E. coli 83972 reduced catheter colonization by E. faecalis 210 more than 10-fold. Enterococcus alone catheters had a median of 9.7 x 10(5) enterococci per cm., whereas E. coli plus Enterococcus catheters had a median of 0.38 x 10(5) enterococci per cm. (p = 0.016). CONCLUSIONS: Pre-inoculating urinary catheters with E. coli 83972 significantly impedes catheter colonization by Enterococcus: These promising in vitro results prompt the clinical investigation of this particular application of bacterial interference.