Two-year analysis of Clostridium difficile ribotypes associated with increased severity.

BACKGROUND: Certain Clostridium difficile ribotypes have been associated with complex disease phenotypes including recurrence and increased severity, especially the well-described hypervirulent RT027. This study aimed to determine the pattern of ribotypes causing infection and the association, if any, with severity. METHODS: All faecal samples submitted to a large diagnostic laboratory for C. difficile testing between 2011 and 2013 were subject to routine testing and culture. All C. difficile isolates were ribotyped, and associated clinical and demographic patient data were retrieved and linked to ribotyping data. RESULTS: In total, 86 distinct ribotypes were identified from 705 isolates of C. difficile. RT002 and RT015 were the most prevalent (22.5%, N=159). Only five isolates (0.7%) were hypervirulent RT027. Ninety of 450 (20%) patients with clinical information available died within 30 days of C. difficile isolation. RT220, one of the 10 most common ribotypes, was associated with elevated median C-reactive protein and significantly increased 30-day all-cause mortality compared with RT002 and RT015, and with all other ribotypes found in the study. CONCLUSIONS: A wide range of C. difficile ribotypes were responsible for C. difficile infection presentations. Although C. difficile-associated mortality has reduced in recent years, expansion of lineages associated with increased severity could herald increases in future mortality. Enhanced surveillance for emerging lineages such as RT220 that are associated with more severe disease is required, with genomic approaches to dissect pathogenicity.

The place of SGML and HTML in building electronic patient records.

The authors are concerned that, although popular, SGML (Standard Generalized Markup Language) is only one approach to capturing, storing, viewing and exchanging healthcare information and does not provide a suitable paradigm for solving most of the problems associated with paper based patient record systems. Although a discussion of the relative merits of SGML, HTML (HyperText Markup Language) may be interesting, we feel such a discussion is avoiding the real issues associated with the most appropriate way to model, represent, and store electronic patient information in order to solve healthcare problems, and therefore the medical informatics community should firstly concern itself with these issues. The paper substantiates this viewpoint and concludes with some suggestions of how progress can be made.

Enhancing lineup identification accuracy: two codes are better than one.

Ways of improving identification accuracy were explored by comparing the conventional visual lineup with an auditory/visual lineup, one that paired color photographs with voice recordings. This bimodal lineup necessitated sequential presentation of lineup members; Experiment 1 showed that performance in sequential lineups was better than performance in traditional simultaneous lineups. In Experiments 2A and 2B unimodal and bimodal lineups were compared by using a multiple-lineup paradigm: Ss viewed 3 videotaped episodes depicting standard police procedures and were tested in 4 sequential lineups. Bimodal lineups were more diagnostic than either visual or auditory lineups alone. The bimodal lineup led to a 126% improvement in number of correct identifications over the conventional visual lineup, with no concomitant increase in number of false identifications. These results imply strongly that bimodal procedures should be adopted in real-world lineups. The nature of memorial processes underlying this bimodal advantage is discussed.