Fosaprepitant for the Treatment of Refractory Postoperative Nausea and Vomiting.

Postoperative nausea and vomiting (PONV) is a debilitating condition that occurs in approximately 30% of patients undergoing general anesthesia. Premedication with 5-HT3 receptor antagonists and glucocorticoids is effective in clinical practice; however, 10% to 20% of patients still develop PONV. Currently, little is known about the treatment of refractory PONV. We present a case that illustrates the use of fosaprepitant for the treatment of refractory postoperative nausea and vomiting.

Impact of catheter antimicrobial coating on species-specific risk of catheter colonization: a meta-analysis.

BACKGROUND: Antimicrobial catheters have been utilized to reduce risk of catheter colonization and infection. We aimed to determine if there is a greater than expected risk of microorganism-specific colonization associated with the use of antimicrobial central venous catheters (CVCs). METHODS: We performed a meta-analysis of 21 randomized, controlled trials comparing the incidence of specific bacterial and fungal species colonizing antimicrobial CVCs and standard CVCs in hospitalized patients. RESULTS: The proportion of all colonized minocycline-rifampin CVCs found to harbor Candida species was greater than the proportion of all colonized standard CVCs found to have Candida. In comparison, the proportion of colonized chlorhexidine-silver sulfadiazine CVCs specifically colonized with Acinetobacter species or diphtheroids was less than the proportion of similarly colonized standard CVCs. No such differences were found with CVCs colonized with staphylococci. CONCLUSION: Commercially-available antimicrobial CVCs in clinical use may become colonized with distinct microbial flora probably related to their antimicrobial spectrum of activity. Some of these antimicrobial CVCs may therefore have limited additional benefit or more obvious advantages compared to standard CVCs for specific microbial pathogens. The choice of an antimicrobial CVC may be influenced by a number of clinical factors, including a previous history of colonization or infection with Acinetobacter, diphtheroids, or Candida species.

Validation of interactive voice response system administration of the Short Inflammatory Bowel Disease Questionnaire.

BACKGROUND: The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) is a written, self-administered instrument measuring quality of life in IBD. We assessed the validity of an interactive voice response system (IVRS) as a new mode of administering the SIBDQ. METHODS: An IVRS was designed using prerecorded questions to collect data via touchtone telephone. Subjects with Crohn's disease (CD) or ulcerative colitis (UC) were randomized into 2 groups with different orders of administration: written, self-administered followed by IVRS (S-I) or IVRS followed by written, self-administered (I-S). Half of the S-I group was also randomized to receive a second IVRS. Sixty-four subjects were studied: 30 in S-I, 34 in I-S. RESULTS: The mean SIBDQ scores were not different between written and IVRS modes (P = 0.26) with r = 0.93. IVRS scores were lower in active than inactive CD (36.1 +/- 9.6 versus 54.7 +/- 8.6, P < 0.001) and lower in active than inactive UC (40.8 +/- 9.6 versus 59.8 +/- 10.0, P < 0.001). Mean scores correlated highly with disease activity indices, and were not different between first and second IVRS administrations (P = 0.85) with r = 0.92. IVRS had excellent internal consistency (Cronbach alpha = 0.90). CONCLUSIONS: IVRS administration of the SIBDQ yields results similar to written self-administration, with excellent procedural validity, test-retest reliability, and internal consistency.