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Objective-This pilot study in parenteral nutrition (PN) dependent infants with short bowel syndrome (SBS) evaluated the impact of feeding route and intestinal permeability on bloodstream infection (BSI), small bowel bacterial overgrowth (SBBO) and systemic immune responses, and fecal calprotectin as a biomarker for SBBO.Study design-10 infants (ages 4.2-15.4 months) with SBS due to necrotizing enterocolitis were evaluated. Nutritional assessment, breath hydrogen testing, intestinal permeability, fecal calprotectin, serum flagellin-and LPS-specific antibody titers, and proinflammatory cytokine concentrations (TNF-α, IL-1 β, IL-6, IL-8) were performed at baseline, 60 and 120 days. Healthy, age-matched controls (n=5) were recruited.Results-BSI incidence was high (80%) and SBBO was common (50%). SBBO increased the odds for BSI (> 7-fold; p=0.009). Calprotectin levels were higher in children with SBS and SBBO versus those without SBBO and healthy controls (p<0.05). Serum TNF-α, was elevated at baseline versus controls. Serum TNF-α, IL-1 β, IL-6 and IL-8 levels diminished with increased enteral nutrition. Anti-flagellin and anti-LPS IgG levels in children with SBSwere lower versus controls and rose over time.Contact Information: Conrad R. Cole. M.D., M.P.H., M.Sc., Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta GA 30225, crcole@emory.edu, Phone: (404) Fax: (404) 727-4069. Edited by SL and WFB Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion-In children with SBS, SBBO increases the risk for BSI and systemic proinflammatory response decreases with increasing enteral feeding and weaning PN. NIH Public AccessShort bowel syndrome (SBS) is a rare but devastating clinical entity that is defined as a spectrum of diarrhea and malabsorption with associated complications (e.g. growth stunting, malnutrition) due to insufficient bowel length (1). In children, SBS is often the result of massive small bowel resection due to necrotizing enterocolitis (NEC) or major congenital gastrointestinal malformations (e.g. gastroschisis, intestinal atresia) (2). Recurrent bloodstream infections (BSI) and small bowel bacterial overgrowth (SBBO) are believed to be common complications associated with pediatric SBS, though only limited data are available (2,3). We recently reported that BSI and malnutrition were the most frequent indication for readmission of very low birth weight infants with SBS (2). Inpatient admissions account for majority of the cost of care in pediatric...

Patients who had negative beliefs about medications, who were <65 years of age, or who had low medication self-efficacy reported low medication adherence.

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BACKGROUND: Up to 50 % of patients do not take medications as prescribed. Interventions to improve adherence are needed, with an understanding of which patients benefit most. OBJECTIVE: To test the effect of two low-literacy interventions on medication adherence. DESIGN: Randomized controlled trial, 2×2 factorial design. PARTICIPANTS: Adults with coronary heart disease in an inner-city primary care clinic. INTERVENTIONS: For 1 year, patients received usual care, refill reminder postcards, illustrated daily medication schedules, or both interventions. MAIN MEASURES: The primary outcome was cardiovascular medication refill adherence, assessed by the cumulative medication gap (CMG). Patients with CMG< 0.20 were considered adherent. We assessed the effect of the interventions overall and, post-hoc, in subgroups of interest. KEY RESULTS: Most of the 435 participants were elderly (mean age = 63.7 years), African-American (91 %), and read below the 9th-grade level (78 %). Among the 420 subjects (97 %) for whom CMG could be calculated, 138 (32.9 %) had CMG<0.20 during followup and were considered adherent. Overall, adherence did not differ significantly across treatments: 31.2 % in usual care, 28.3 % with mailed refill reminders, 34.2 % with illustrated medication schedules, and 36.9 % with both interventions. In post-hoc analyses, illustrated medication schedules led to significantly greater odds of adherence among patients who at baseline had more than eight medications (OR=2.2; 95 % CI, 1.21 to 4.04) or low self-efficacy for managing medications (OR=2.15; 95 % CI, 1.11 to 4.16); a trend was present among patients who reported non-adherence at baseline (OR= 1.89; 95 % CI, 0.99 to 3.60). CONCLUSIONS: The interventions did not improve adherence overall. Illustrated medication schedules may improve adherence among patients with low selfefficacy, polypharmacy, or baseline non-adherence, though this requires confirmation.KEY WORDS: coronary heart disease; medical adherence; medication management.

The decreasing incidence of IPD in Atlanta since 2000-2001 was associated with decreases in cases of pneumonia and meningitis in adult and pediatric subjects and in cases of primary bacteremia in children. The burden of serotype-replacement disease remained small. Adults with comorbidities represent a growing proportion of patients with IPD.

Objective To investigate the effect of Vitamin D3 on physical performance in patients with HF. Background HF is associated with functional decline and frailty. Vitamin D deficiency is associated with loss of muscle strength and poor outcomes in patients with HF. Methods: Sixty-four patients participated in a 6-month parallel design double blind RCT to test the hypothesis that oral vitamin D3 would improve physical performance. Vitamin D3 50,000 IU or placebo was given weekly; all received daily calcium. Patients were included regardless of EF and 25OHD ≤ 37.5 ng/ml. The primary outcome was peak VO2, and secondary outcomes were the 6MW, TGUG and knee isokinetic muscle strength. Between group comparisons were made using ANCOVA models that adjust for baseline measures. Results Patients were age 65.9 ± 10.4 years old, 48% women, 64% African American, EF 37.6±13.9, 36% NYHA III, the remainder NYHA II. At baseline the vitamin D group 25OHD was 19.1 ± 9.3 ng/ml and increased to 61.7 ± 20.3 ng/ml; in the placebo group baseline 25OHD was 17.8 ± 9.0 ng/ml and decreased to 17.4 ± 9.8 ng/ml at 6 months (between groups p<0.001). There was no significant change from baseline to 6 months in peak VO2, 6MW, TGUG or isokinetic muscle strength. Conclusions Vitamin D3 did not improve physical performance for patients with HF despite a robust increase in serum 25OHD. Vitamin D repletion in patients with HF should conform to standard adult guidelines for vitamin D supplementation.