Clostridium difficile in England: can we stop washing our hands?

Dingle and colleagues1 provide compelling evidence that the substantial decline in Clostridium difficile infection in England since 2006 resulted from the disappearance of fluoroquinolone-resistant isolates. However, attribution of this decline to specific control measures rests on a false premise. The authors state that “if decreases in Clostridium difficile infection were driven by improvements in hospital infection control, then transmitted (secondary) cases should decline regardless of susceptibility”.1 In fact, non-specific hospital infection control measures such as hand hygiene, environmental cleaning, and patient isolation will have a disproportionate effect on resistant strains, provided these strains spread preferentially in the hospital setting

Mainebiz focus. Description by attorneys Geoff Cummings and Jeff Young of Mai

Mainebiz focus. Description by attorneys Geoff Cummings and Jeff Young of Maine\u27s status as an employment at-will state

Fatigue in early, intensively treated and tight-controlled rheumatoid arthritis patients is frequent and persistent: a prospective study

Fatigue has a large impact on quality of life and is still unmanageable for many patients. Study aims were describe (1) the prevalence and pattern of fatigue over time in patients with early rheumatoid arthritis under a treat-to-target strategy and (2) identify predictive factors for worsening and recovering of fatigue over time. Data from the tREACH study were used, comparing different treatment strategies with fatigue as secondary objective. Patient outcomes on fatigue, quality of life, depression, and coping were obtained every 6 months and clinically assessed every 3 months. Prediction of fatigue at 12 months was investigated with an ROC curve. Analysis was stratified into non-fatigue and fatigue at baseline. Logistic regression was used for the evolution of fatigue in relation with the covariates over time. Almost half of all patients (n = 246) had high fatigue levels at baseline, decreasing slightly over time. At 12 months, 43% of patients were fatigued; while 23% of the initially fatigued patients showed lower levels of fatigue, the fatigue level had increased in 15% of the initially non-fatigued patients. The strongest predictor of fatigue was the previous fatigue levels (AUC 0.89). Higher score on the depression scale and coping with limitations was associated with developing fatigue over time in the initially non-fatigued group. Despite a strict treat-to-target strategy, fatigue remained an overall problem during the first year of treatment, and was mainly predicted by its baseline status. In subgroups, a small additional effect of depression was seen. Monitoring fatigue and depression may be important in managing fatigue