Whipple disease

Supplements' effects on patient infections and well-being

Annals of Internal Medicine

March 4, 2003

Dietary supplements are used extensively throughout the United States. This randomized double-blinded, placebo-controlled trial was conducted in two primary care clinics to determine the effect of a daily multivitamin and mineral supplement on infection and well-being. (1) One hundred thirty adults were stratified by age (ie, 45 to 64 years, [greater than or equal to] 65 years) and diabetes status (ie, type 2 diabetes mellitus). Participants were assigned randomly to one of two groups. The treatment group, which consisted of 63 participants, received one oral tablet containing vitamins and minerals daily for one year. The other 67 study participants received a placebo. Nutritional status was assessed from food diaries maintained by the participants, infection was determined from a daily symptom checklist diary, and well-being was determined using the Medical Outcomes Study 12-Item Short Form scale. Descriptive statistics, including univariate and multivariate analysis techniques were used to evaluate the differences between the treatment and placebo groups.

Findings. Participants in the placebo group were significantly more likely to report having an infection (73% versus 43%, P < 0.001) than participants who received a daily multivitamin and mineral supplement. Significantly more participants with diabetes in the placebo group reported infections than those in the treatment group (93% versus 17%, P < 0.001). Multivariate analysis revealed that the use of a multivitamin and mineral supplement had no effect on well-being as measured by the Medical Outcomes Study 12-Item Short Form scores (difference 1.02, confidence interval [CI] -2.22 to 4.2 for the treatment group and difference 0.98, CI -1.97 to 3.94 for the placebo group).

Clinical implications. Although no difference was found in well-being between the group that took a daily multivitamin and mineral supplement and the group that did not, patients with diabetes who took the daily supplements were significantly less likely to report an infection. These results strongly suggest that the use of a daily supplement can reduce the risk of infection in patients with diabetes. Perioperative nurses should consider incorporating this finding in their educational encounters with patients identified as having type 2 diabetes.

Music and patient anxiety

AORN Journal

February 2003

The use of music as a healing medium to restore, maintain, and improve emotional, physical, physiological and spiritual health and well-being dates back to ancient times. Listening to music during surgery may help the time pass more quickly, mask background noises, and divert patients' attention from the surgical procedure. The objective of this quantitative study was to assess the effectiveness of music as a relaxation technique. (2) Eighty patients scheduled for minor surgical procedures under local anesthesia in an acute care hospital in Hong Kong were assigned on alternate weeks to either a control or an experimental group. In addition to receiving routine preoperative instructions, patients in the experimental group were given a choice of taped music to listen to through headphones. Patients in the control group received only the routine preoperative instructions. The effectiveness of music as a relaxation technique was assessed by measurement of patient's vital signs. The Chinese State-Trait Anxiety Inventory was used to assess procedure-related anxiety level. Descriptive statistics were used to analyze differences between the two groups.

Findings. Patients in the group that listened to music had significantly lower anxiety scores, lower heart rates, and lower blood pressure. Paired samples to compare pretest and posttest variables for both groups revealed that patients in the experimental group demonstrated a significant decrease from pretest to posttest in the four variables: anxiety level (pretest mean [M] 53.58, standard deviation [SD] 8.88; posttest M 31.83, SD 4.97, t value 14.91, P < 0.001), heart rate (pretest M 82.50, SD 10.05; posttest M 78.13, SD 10.69; t value 3.29 P < 0.001), systolic blood pressure (t value 3.67, P < 0.001), and diastolic blood pressure (t value 2.96, P = 0.002).

Clinical implications. This study suggests that listening to slow or moderate music, a relatively inexpensive intervention, can reduce patients' anxiety. Perioperative nurses must understand, however, that the love of music is not universal. Consequently, if this intervention is chosen, an assessment of a patient's likes and dislikes in music must be undertaken first.

Blood loss predictors in hip fracture surgery

Journal of the Royal College of Surgeons of Edinburgh

June 2002

Hip fractures are a common injury, especially in older adults. Such injuries generally require hospitalization and surgery. The objective of this prospective study was to identify predictors of excessive blood loss during surgical treatment for hip fractures (3) Data from 242 consecutive patients undergoing a surgical procedure for hip fractures in England were reviewed. Blood loss was assessed by noting the blood volume in the suction canisters and weighing sponges. Excessive blood loss was defined as blood loss of more than 480 mL. Variables assessed included patient demographics, preoperative hemoglobin, type of procedure, blood loss, pre-existing medical conditions, the American Society of Anesthesiology (ASA) score, and patients' risk of cerebral or cardiac ischemia from volume depletion as defined by the American College of Physicians (ACP). Multiple logistic regression techniques were used to analyze the variables.

Findings. Logistic regression analysis revealed that excessive blood loss was significantly associated with the following variables: patients at risk as defined by the ACP (odds ratio [OR] 2.82, CI 1.63-4.94, P = 0.0003), ASA score of 3 and 4 (OR 2.58, CI 1.5-4.45, P = 0.001), the presence of more than two preexisting medical conditions (OR 3.21, CI 1.81-5.72, P < 0.0001), and procedure type: hemiarthroplasty (OR 3.73, CI 2.11-6.51, P < 0.0001).

Clinical implications. Perioperative nurses should be prepared to assist with blood transfusion in patients with an ASA score of 3 or 4 who are undergoing a hemiarthroplasty procedure.

Transmission of Whipple's disease via gastroscopes

Infection Control and Hospital Epidemiology

March 2003

Whipple's disease is a rare malabsorption illness caused by Tropheryma whippelii bacteria. It interferes with the body's ability to absorb certain nutrients. Diagnosis is based on symptoms and the results of a biopsy of tissue from the small intestine. The diagnosis of Whipple's disease in two patients who were negative for the disease by biopsy three years before suggested that the disease may be transmitted by gastroscopes. The objective of this study was to determine whether current high-level disinfecting protocols for gastroscopes are effective against T whippelii. (4) Two disinfectant solutions, 2% glutaraldehyde and peracetic acid, were inoculated in [10.sup.5] primary inclusion-forming units of T whippelii. Sterile water was used as a negative control and a suspension of Pseudomonas aeruginosa [10.sup.5] colony forming units was used as a positive control. All experiments were performed in triplicate and repeated twice.

Findings. T whippelii was reduced by approximately 2.5 [log.sub.10] after five and 10 minutes and 3 [log.sub.10] after 20 to 60 minutes contact time with glutaraldehyde. Reductions in viable bacteria were approximately 2 [log.sub.10] after 20 minutes and approximately 3 [log.sub.10] after 30 minutes with peracetic acid.

Clinical implications. Bactericidal activity of disinfecting solutions generally is considered significant if it results in a 5 [log.sub.10] or greater reduction in viable bacterial titers. Perioperative nurses should understand that disinfecting gastroscopes with 2% gluteraldehyde or peracetic acid according to the current 20-minute protocol for high-level disinfection may not be effective in preventing the transmission of T whippelii. Consequently, if a biopsy is being performed and T whippelii is suspected, alternative procedures for reprocessing the gastroscope should be considered seriously.

This information is intended for general use only. The clinical implications are specific to the abstracted article only. Individuals intending to put these findings into practice are strongly encouraged to review the original article to determine its applicability to their setting.

NOTES

(1.) T A Barringer, et al, "Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial," Annals of Internal Medicine 138 (March 4, 2003) 365-371.

(2.) E Mok, K Wong, "Effects of music on patient anxiety," AORN Journal 77 (February 2003) 396-410.

(3.) A O Odumala, C I Ayekoloye, G Packer, "Predictors of excessive blood logs during operative treatment of hip fractures," Journal of the Royal College of Surgeons of Edinburgh 47 (June 2002) 552-556.

(4.) B LaScola et al, "Can Whipple's disease be transmitted by gastroscopes?" Infection Control and Hospital Epidemiology 24 (March, 2003) 191-194.

GEORGE ALLEN

RN, PHD, CNOR, CIC

NURSING RESEARCH COMMITTEE

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