Study protocol of a double-blind randomised placebo-controlled trial on the effect of a multispecies probiotic on the incidence of antibiotic-associated diarrhoea in persons with spinal cord injury.

STUDY DESIGN: Multi-centre, double-blind randomised placebo-controlled study. OBJECTIVE: To investigate whether the use of a multispecies probiotic can prevent antibiotic-associated diarrhoea in people with spinal cord injury (SCI). SETTING: Three Dutch SCI rehabilitation centres. METHODS: Fifty-six people aged 18-75 years with SCI during inpatient rehabilitation, who require antibiotics, will be given probiotics or placebo randomly assigned (T0). After cessation of the antibiotics (T1), the participants will use probiotics/placebo for 3 more weeks (T2). Defaecation, assessed by the Bristol Stool Scale, and bowel management will be monitored daily until 2 weeks after cessation of probiotics/placebo intake (T3). Also, the degree of nausea and information on quality of life will be collected at T0, T1, T2 and T3. MAIN OUTCOME MEASURES: The difference between the incidence of antibiotic-associated diarrhoea between people with SCI using probiotics compared to those using a placebo at the moment the antibiotics stops, the probiotics stops and two weeks thereafter. SECONDARY OUTCOME MEASURES: The time to reach effective bowel management, degree of nausea and quality of life. REGISTRATION: The Dutch Trial Register- NTR 5831.

Randomized clinical trial on the effect of a multispecies probiotic on visceroperception in hypersensitive IBS patients.

BACKGROUND: Irritable bowel syndrome (IBS) is characterized by heterogeneous pathophysiology and low response to treatment. Up to 60% of IBS patients suffers from visceral hypersensitivity, which is associated with symptom severity and underlying pathophysiological mechanisms. Recently, positive effects of probiotics in IBS have been reported, but overall the response was modest. We performed a study in IBS patients, characterized by visceral hypersensitivity measured with the rectal barostat, aiming to assess the effect of 6 weeks of multispecies probiotic mix on visceral pain perception. METHODS: We conducted a randomized, placebo-controlled, double-blind trial in forty Rome III IBS patients with visceral hypersensitivity. Prior to intake, patients kept a 2-week symptom diary and underwent a rectal barostat measurement. When hypersensitivity was confirmed, participation was allowed and patients received a multispecies probiotic with in vitro proven potential beneficial effects on mechanisms contributing to visceral hypersensitivity (six different probiotic strains; 10(9)  cfu/g), or a placebo product of one sachet (5 g) per day for 6 weeks. At the end of the intervention period, visceroperception and symptoms were reassessed. KEY RESULTS: Thirty-five patients completed the trial. The percentage of patients with visceral hypersensitivity decreased significantly in the probiotic and placebo group (76.5% and 71.4%, respectively; N.S. between groups). Improvement in pain scores and mean symptom score did not differ between the probiotic and placebo group. CONCLUSIONS & INFERENCES: In this placebo-controlled trial in IBS patients with visceral hypersensitivity, no significant effect of a multispecies probiotic on viscerperception was observed. The study has been registered in the US National Library of Medicine (http://www.clinicaltrials.gov, NCT00702026).

Does meal ingestion enhance sensitivity of visceroperception assessment in irritable bowel syndrome?

BACKGROUND: Visceral hypersensitivity is frequently observed in irritable bowel syndrome (IBS). Previous studies have shown that administration of a meal can aggravate symptoms or increase visceroperception in IBS patients. We investigated whether meal ingestion could increase the sensitivity of the barostat procedure for the detection of visceral hypersensitivity in IBS patients. METHODS: Seventy-one IBS patients and 30 healthy controls (HC) were included in the study. All subjects underwent a barostat procedure under fasted and postprandial conditions to measure visceroperception. Urge, discomfort, and pain were scored on a visual analog scale. Furthermore, percentages of hypersensitive IBS patients and HC were calculated and dynamic rectal compliance was assessed. KEY RESULTS: In IBS patients, urge, discomfort, and pain scores were significantly increased postprandially vs the fasted state. The HC showed increased scores for urge and pain only. Rectal dynamic compliance remained unaltered in both groups. Postprandial hypersensitivity percentages did not significantly differ vs the fasted state in IBS patients, nor in HC. CONCLUSIONS & INFERENCES: Postprandial barostat measurement enhances visceroperception in IBS but has no added value to detect visceral hypersensitivity in individual IBS patients.

Increasing the revenues from automatic milking by using individual variation in milking characteristics.

The objective of this study was to quantify individual variation in daily milk yield and milking duration in response to the length of the milking interval and to assess the economic potential of using this individual variation to optimize the use of an automated milking system. Random coefficient models were used to describe the individual effects of milking interval on daily milk yield and milking duration. The random coefficient models were fitted on a data set consisting of 4,915 records of normal uninterrupted milkings collected from 311 cows kept in 5 separate herds for 1 wk. The estimated random parameters showed considerable variation between individuals within herds in milk yield and milking duration in response to milking interval. In the actual situation, the herd consisted of 60 cows and the automatic milking system operated at an occupation rate (OR) of 64%. When maximizing daily milk revenues per automated milking system by optimizing individual milking intervals, the average milking interval was reduced from 0.421 d to 0.400 d, the daily milk yield at the herd level was increased from 1,883 to 1,909 kg/d, and milk revenues increased from euro498 to euro507/d. If an OR of 85% could be reached with the same herd size, the optimal milking interval would decrease to 0.238 d, milk yield would increase to 1,997 kg/d, and milk revenues would increase to euro529/d. Consequently, more labor would be required for fetching the cows, and milking duration would increase. Alternatively, an OR of 85% could be achieved by increasing the herd size from 60 to 80 cows without decreasing the milking interval. Milk yield would then increase to 2,535 kg/d and milk revenues would increase to euro673/d. For practical implementation on farms, a dynamic approach is recommended, by which the parameter estimates regarding the effect of interval length on milk yield and the effect of milk yield on milking duration are updated regularly and also the milk production response to concentrate intake is taken into account.

Antimicrobial activity of a multispecies probiotic (Ecologic 641) against pathogens isolated from infected pancreatic necrosis.

AIMS: Although probiotic prophylaxis has been suggested to prevent small bowel bacterial overgrowth, bacterial translocation and infection of pancreatic necrosis in severe acute pancreatitis, limited data are available on their antimicrobial activity. METHODS AND RESULTS: Using the well-diffusion method, we studied the antimicrobial properties of a multispecies probiotic product (Ecologic 641) against a collection of pathogens cultured from infected pancreatic necrosis. All individual probiotic strains included in the multispecies preparation were able to inhibit the growth of the pathogens to some extent. However, the combination of the individual strains (i.e. the multispecies preparation) was able to inhibit all pathogenic isolates. Probiotic-free supernatants adjusted to pH 7 were not able to inhibit pathogen growth. CONCLUSION: Ecologic 641 is capable of inhibiting growth of a wide variety of pathogens isolated from infected pancreatic necrosis. The antimicrobial properties are to a large extent explained by the production of organic acids. SIGNIFICANCE AND IMPACT OF THE STUDY: Ecologic 641 is currently being used in a Dutch nationwide double-blind, placebo-controlled, randomized multicentre trial in patients with predicted severe acute pancreatitis.

Monostrain, multistrain and multispecies probiotics--A comparison of functionality and efficacy.

This literature review was carried out to make a comparison of functionality and efficacy between monostrain, multistrain and multispecies probiotics. A monostrain probiotic is defined as containing one strain of a certain species and consequently multistrain probiotics contain more than one strain of the same species or, at least of the same genus. Arbitrarily, the term multispecies probiotics is used for preparations containing strains that belong to one or preferentially more genera. Multispecies probiotics were superior in treating antibiotic-associated diarrhea in children. Growth performance and particularly mortality in broilers could be improved with multistrain probiotics. Mice were better protected against S. Typhimurium infection with a multistrain probiotic. A multispecies probiotic provided the best clearance of E. coli O157:H7 from lambs. Rats challenged with S. Enteritidis showed best post-challenge weight gains when treated with a multispecies probiotic. Possible mechanisms underlying the enhanced effects of probiotic mixtures are discussed. It is also emphasized that strains used in multistrain and multispecies probiotics should be compatible or, preferably, synergistic. The design and use of multistrain and multispecies probiotics should be encouraged.

The development of the 'Quality-of-life for Respiratory Illness Questionnaire (QOL-RIQ)': a disease-specific quality-of-life questionnaire for patients with mild to moderate chronic non-specific lung disease.

Chronic non-specific lung disease (CNSLD) encompasses asthma as well as chronic obstructive pulmonary disease (COPD). Recently in health care, there has been increasing awareness in the functional, psychological and social aspects of the health of patients; their quality of life (QOL). Quality-of-life research addressing CNSLD patients has been rather underdeveloped for a long period of time. Recently, however, the importance of QOL is being increasingly recognized, and several research groups have started to study QOL in CNSLD patients in more detail. This paper describes the construction of a disease-specific QOL instrument for patients with mild to moderately severe CNSLD. Items relating to several domains of QOL were listed, and 171 CNSLD patients in general practice were asked how much of a problem each item had been (assessed on a seven-point Likert scale). After applying an item-selection procedure, a uni-dimensional QOL questionnaire was constructed consisting of 55 items divided into seven domain subscales: breathing problems, physical problems, emotions, situations triggering or enhancing breathing problems, general activities, daily and domestic activities, and social activities, relationships and sexuality. Reliability estimates of the domain subscales of the constructed questionnaire varied from 0.68 to 0.89, and was 0.92 for the QOL for Respiratory Illness Questionnaire (QOL-RIQ) total scale. A first impression of the construct validity of the questionnaire was gained by investigation of the relationship between the QOL domain subscales and several indicators of illness severity, as well as the relative contribution of illness severity variables, background characteristics and symptoms to QOL, using regression analysis. Further research to validate the questionnaire to a greater extent (construct validity, test-retest reliability and responsiveness to change) is currently taking place.

[A closer look at the milking machine]. / De melkmachine nader bekeken.

Machine milking has changed enormously in the past decades. The simple milking machine developed at the end of the nineteenth century has become a complex appliance which removes milk from the udder in a fast and efficient way. There is no doubt about the importance of a well functioning milking machine as regards milk quality and udder health. This article reviews the literature on the basic mechanics of machine milking, with special emphasis on the action of the cluster during milking. The movement of the teat cup liner is particularly important in influencing the efficiency of milk extraction and udder health. Therefore special attention is paid to the operation of the liner, how it works, and how the opening and closing of the liner affects the milking process. The functioning of the pulsator, the vacuum fluctuations occurring during milking, and the effect of these fluctuations on the opening and closing of the liner are discussed. The maintenance of the milking machine is also described.

[Machine milking and udder health: a literature review]. / Melkwinning en uiergezondheid: een literatuuroverzicht.

This article reviews the influence of machine milking on udder health. The main risks are transmission and penetration of pathogens during milking. Pathogens can be transmitted via the hands, cloths, and liners. Irregular fluctuations in the vacuum can cause penetration of mastitis pathogens into or through the teat canal. Such fluctuations are caused by air blasts in the milking machine. Machine milking can also cause teat lesions, although only severe lesions give rise to new infections. Preliminary research results on the influence of the frequency and degree of udder evacuation show that the clinical symptoms of mastitis generally decreases as the frequency and completeness of milking increase. It is concluded that machine milking can influence udder health but that the influence strongly depends on the exposure to pathogens and the quality of the milker.

Patients' opinions on respiratory care: do doctors fulfill their needs?

To date, guidelines and consensus reports on quality care for asthma and chronic obstructive pulmonary disease (COPD) are mainly based on research and opinions of care providers. Patients' viewpoints on good medical care have rarely been studied. We designed a postal questionnaire to study the needs of patients with asthma or COPD for medical care provided by general practitioners and lung physicians. A total of 121 patients filled out the questionnaire, which included 111 items about needs. Although generally satisfied, patients reported several unfulfilled needs. Main topics were the need for information about diagnostic tests, prognosis, and long-term use of medication. In addition, patients wanted more written information about the nature of their disease. One-third of patients wanted more participation in decisions about their treatment. These results suggest the quality of medical care for patients with asthma or COPD can be improved by adjusting provided care to needs expressed by patients.

Developing a quality-of-life questionnaire for patients with respiratory illness.

In this short report, the construction of a disease-specific quality-of-life questionnaire for patients with asthma and chronic obstructive pulmonary disease (COPD) is described. Some psychometric aspects are also discussed. We listed 221 items relating to several domains of quality-of-life, and asked 204 patients to indicate, on a seven-point Likert-scale, how much of a problem each item had been during the last year. After item selection, a quality-of-life scale was constructed, consisting of 55 items divided into 7 subscales. The reliability estimates vary from 0.68 to 0.89, and can be considered as quite satisfactory. Results concerning construct validity are promising; there is a strong relationship between the Quality-of-life subscales and several indicators of illness severity. Further research is called for to validate the questionnaire.