Frank D'amico

A Randomized Clinical Trial Measuring the Influence of Kefir on Antibiotic-Associated Diarrhea: The Measuring the Influence of Kefir (MILK) Study

OBJECTIVE To examine the role of commercially available kefir, a fermented milk similar to yogurt but containing different fermentation microbes, in preventing antibiotic-associated diarrhea (AAD). Probiotics have shown some promise in preventing AAD. DESIGN A double-blinded randomized placebo-controlled allocation concealment clinical trial. SETTING Primary care patients in the Washington, DC, metropolitan area. PARTICIPANTS A total of 125 children aged 1 to 5 years presenting to primary care physicians. Intervention Kefir drink or heat-killed matching placebo. Main Outcome Measure The primary outcome was the incidence of diarrhea during the 14-day follow-up period in children receiving antibiotics. RESULTS There were no differences in the rates of diarrhea per group, with 18% in the active group and 21.9% in the placebo group (relative risk, 0.82; 95% confidence interval, 0.54-1.43). Additionally, there were no differences in any secondary outcomes among the groups. However, there were some interesting interactions among initial health at enrollment, age of participants, and sex that require further study. CONCLUSIONS In our trial, kefir did not prevent AAD. Further independent research on the potential of kefir needs to be conducted.

Standardized symptomatic treatment versus penicillin as initial therapy for streptococcal pharyngitis

A multicenter, double-blind, randomized, placebo-controlled trial was conducted to determine whether the addition of penicillin was superior to patient education and anti-inflammatory drug therapy for relief of the acute discomforts of pharyngitis caused by group A beta-hemolytic streptococcus (GABHS). One hundred seventy-eight patients, aged 4 to 29 years, received appropriate symptomatic therapy, including specific doses of aspirin or acetaminophen, plus penicillin (91 patients) or placebo (87) for the initial 48 hours of illness. All had 24-hour office and 48-hour telephone reevaluations. In 123 patients (57 with clinically severe pharyngitis), throat cultures yielded GABHS. Penicillin provided a margin of 20% improvement over anti-inflammatory therapy for the complaint of sore throat only after 48 hours of treatment (for the 123 patients with GABHS, p = 0.01; for the 57 with both severe pharyngitis and GABHS, p = 0.05). No significant improvement was noted for fever, malaise, odynophagia, exudate, adenitis, or pharyngitis. The failure of penicillin to provide much additional benefit makes its routine early prescription specifically for symptomatic relief questionable.

Five-Year Follow-Up Of A Nurse-Initiated Intervention To Improve Mammography Recommendation

Background: In a previous study we found immediate effectiveness of a nurse-initiated intervention on improving mammography recommendation rates in a family practice residency program. To determine the long-term effectiveness of this ongoing intervention, we performed a chart audit study on two different groups of charts 5 years after the institution of the intervention. Methods: Chart audits for mammogram recommendation and completion rates were conducted on an original cohort group of women aged 40 years and older (n = 91) and a new 5-year postintervention group of women aged 53 years and older (n = 189). Preintervention, postintervention, and 5-year postintervention rates were compared within the cohort group. Rates of the new 5-year postintervention group were compared with rates of women 50 years and older from the original pre intervention group and postintervention group. Results: For the original cohort group the improvement in “mammograms done at least once in the past 3 years” was maintained 5 years later, and there was a statistically significant increased rate from the postintervention to 5 years later (73.9 percent versus 86.8 percent, P<0.02) for “mammograms done or recommended at least once in the past 3 years.” This improvement was also noted for the new 5-year postintervention group when their rates were compared with the pre intervention and postintervention group rates. For “mammograms done at least once in the past 3 years,” the rates were 34.2 percent, 45.5 percent, and 64 percent, respectively. For “mammograms done or recommended at least once in the past 3 years,” the rates were 42.6 percent, 72.7 percent, and 90.0 percent, respectively. In a separate analysis, annual mammogram rates in the new 5-year postintervention group for the 3 years preceding this study were 44.8 percent (1990), 36.5 percent (1991), and 36.5 percent (1992). Eleven percent of women had a mammogram done in each of the 3 consecutive years. Conclusion: An ongoing nurse-initiated intervention is a feasible method of improving and maintaining mammogram recommendation and completion rates. Further studies of interventions to improve the rate at which eligible women get consecutive annual mammograms are needed.

Patient Preferences for Receiving Reports of Test Results

Introduction: The general publics preferences for modes of communication (other than in-person communication) for medical test results were investigated. We hypothesized that patients would prefer a variety of methods to receive common tests results (blood cholesterol and colonoscopy) compared with genetics test results. Methods: This study was a cross-sectional survey. Results: A total of 409 participants responded to the survey. Among these participants, ≥50% reported that they were comfortable receiving results for a blood cholesterol test or colonoscopy via 4 of the 7 non–in-person communication methods (password-protected website, personal voicemail, personal E-mail, and letter were preferred over home voicemail, fax, and mobile phone text message). In comparison, >50% of participants were comfortable with only 1 non–in-person communication method for non-HIV sexually transmitted infections (STIs) and none for genetic tests. Patients were least comfortable receiving any information via fax, regardless of test type. There were statistical differences among comfort levels for blood cholesterol and colonoscopy tests and both STIs and genetic testing for personal voicemail, personal E-mail, mobile phone text message, and password-protected website, but there were no differences between STIs and genetic testing. No correlation was found between “familiarity” with test and “comfort” of receiving information about specific test. Conclusions: Participants demonstrated preferences in how they received test results by non–in-person communication methods, preferring personal E-mail and password-protected websites, but did not prefer fax. Importantly, participants also demonstrated that preference was dependent on test type.