Chronic diarrhoea, weight loss and a positive anti-tissue transglutaminase antibody: A case report of olmesartan-induced enteropathy.

Olmesartan is an angiotensin II receptor blocker licensed for the treatment of hypertension. It can cause a sprue-like enteropathy (SLE), characterised by chronic diarrhoea, weight loss and villous atrophy. Transiently raised anti-tissue transglutaminase (ATTG) antibody has also been rarely reported in the literature.We describe the case of a woman in her mid-50s, who presented with a history of intermittent loose stools over 1 year, associated with significant weight loss. She had two marginally raised serum ATTG antibody tests during her work-up.After extensive investigations, she was diagnosed with olmesartan-induced enteropathy. On subsequent follow-up, her symptoms had resolved with cessation of her olmesartan therapy.This case adds to existing literature, highlighting the importance of considering olmesartan as a possible differential diagnosis for SLE. It also reports the presence of a raised ATTG antibody which is infrequently reported in this context.

Implementing an electronic hand hygiene system improved compliance in the intensive care unit.

BACKGROUND: Hand hygiene (HH) compliance is low and difficult to improve among health care workers. We aim to validate an electronic HH system and assess the impact of this system on HH compliance and quality changes over time at both group and individual levels. METHODS: An automated electronic HH system was installed in a 10-bed surgical intensive care unit. RESULTS: The full HH compliance rate increased significantly from 8.4% in week 1 to 20.5% in week 16 with week 10 being the highest (27.4%). The partial compliance rate maintained relative consistency between 13.2% and 20.0%. The combined compliance rate (full compliance rate + partial compliance rate) increased from 23.5% in week 1 to 34.6% in week 16 with week 10 being the highest (41.4%). DISCUSSION: We found significant variations among providers in terms of HH opportunities per shift, full compliance, partial compliance and combined compliance rates. The average duration of hand rubbing over time in partial compliance occurrences did not change significantly over time. CONCLUSIONS: A sensor-based platform with automated HH compliance and quality monitoring, real time feedback and comprehensive individual level analysis, improved providers' HH compliance in an intensive care unit. There were significant variations among individual providers.

Unmet need for professional mental health care among adolescents with high psychological distress.

OBJECTIVES: This study reports the rate of unmet needs for professional mental health care in a large multi-state sample of adolescents. We also sought to describe barriers to professional help, informal help seeking and future help-seeking intentions among adolescents with wholly unmet needs for counselling for mental illness. METHODS: We collected measures of mental health, help-seeking and unmet needs in 1599 students (817 males and 781 females) in 16 schools (mean age = 17.7 years, standard deviation = 0.42 years). Adolescents meeting 'case' criteria for high psychological distress were classified as having no need, fully met needs, partially met needs or wholly unmet needs. Participants were asked about actual service use, perceived unmet needs, barriers to professional help, help seeking from other sources, use of self-management strategies and future help seeking intentions. RESULTS: In all, 35.7% ( n = 571) of the sample met criteria to be designated 'cases' with high psychological distress. Of these, 25.9% ( n = 148) were classified as having 'wholly unmet needs' (cases of untreated prevalence with self-perceived unmet needs), translating into 9.3% of the original sample. Compared to cases with partially met needs, adolescents with wholly unmet needs engaged in significantly less self-help, used less informal help from family/friends and reported lower future help-seeking intentions. Common barriers to care included a preference for self-management and concerns regarding stigma. CONCLUSIONS: A concerning proportion of adolescents have untreated high psychological distress with wholly unmet mental health needs. This group is rendered particularly vulnerable by low rates of access to non-professional sources of help and low engagement in self-management strategies. Further research is needed to support this vulnerable group to access needed professional mental health help.

Clinical trial of chlorinated polyethylene for facial prosthetics.

PURPOSE: Extraoral maxillofacial prostheses have been fabricated with silicone elastomer for 50 years with few improvements. The objective of this controlled, randomized, prospective, double-blind, single-crossover, multicenter, phase III clinical trial was to determine the noninferiority of chlorinated polyethylene elastomer (CPE) to silicone elastomer for fabricating prostheses. MATERIALS AND METHODS: Forty-two patients were randomly assigned to wear a custom-made prosthesis fabricated from both materials for 4 months and asked to rate their satisfaction (0 = not satisfied, 10 = completely satisfied). Many other measures of prosthesis performance were investigated (see online appendices). RESULTS: Of the 28 patients who completed the study, 68% had used silicone prostheses previously. Overall, patients rated the silicone prosthesis higher than CPE (difference: 2.2, 95% confidence interval [CI]: 0.9 to 3.6, P = .017). Previous users had a stronger preference for silicone (difference: 3.3, 95% CI: 1.7 to 4.9, P = .001), while the 9 new users rated the two materials similarly (difference: 0.0, 95% CI: -2.1 to 2.1, P = 1.00). CONCLUSIONS: The noninferiority of CPE could not be established because of the early termination of the trial. Previous users of silicone prostheses preferred those made of silicone. However, new users expressed no preference between prostheses fabricated with the low-cost CPE or silicone. The authors have developed original clinical trial methodology for assessing extraoral maxillofacial prostheses.