Briefs

By Dolly Ahles and Kathy Dix

Use of gastric acid-suppressive therapy, particularly proton pump inhibitors (PPIs), is associated with an increased risk for an infection that is a significant cause of diarrhea, according to a study in the Dec. 21, 2005 issue of JAMA.

Sandra Dial, MD, MSc, and colleagues from McGill University in Montreal, Canada, conducted a study to determine whether the use of gastric acid-suppressant drugs is associated with the risk of community-acquired CDAD.

While the rates of CDAD in the community are much lower than in the hospital setting, the absolute number of cases in the community could be significant. There has been a significant increase in the rate of C. difficile cases diagnosed in the community from less than 1 per 100,000 persons in 1994 to 22 per 100,000 in 2004. During this period, the rate of prescriptions of antibiotics has decreased and that of proton pump inhibitors has increased. After controlling for certain variables, current use of proton pump inhibitors was associated with nearly three times the rate of CDAD; use of H2-receptor antagonists was associated with twice the rate of CDAD. Current use of NSAIDs but not aspirin was associated with a 30 percent increased rate of C. difficile.

In the December 2005/January 2006 issue, EndoNurse inadvertently printed an incorrect description of the ManoScan 360™ from Sierra Scientific. The correct listing can be viewed on page 12 of this issue.

High Dietary Fiber Intake Not Associated With Reduced Colorectal Cancer Risk

In an analysis combining data from 13 studies, high intake of dietary fiber was not associated with reduced risk of colorectal cancer, according to a study in the Dec. 14, 2005 issue of JAMA.

Dietary fiber has been hypothesized to reduce the risk of colorectal cancer, according to background information in the article. However, the results of numerous epidemiological studies have been inconsistent.

Yikyung Park, ScD, formerly of the Harvard School of Public Health in Boston, and colleagues evaluated the association between dietary fiber intake and risk of colorectal cancer by reanalyzing the primary data from 13 prospective cohort studies (Pooling Project of Prospective Studies of Diet and Cancer). The pooled analysis included 725,628 men and women followed up for six to 20 years across studies.

During the follow-up, 8,081 colorectal cancer cases were identified. Among the studies, median energy-adjusted dietary fiber intake ranged from 14 to 28 g/d in men and from 13 to 24 g/d in women. The major source of dietary fiber varied across studies, with cereals as a major contributor to dietary fiber intake in the European studies, and fruits and vegetables as the main sources in the North American studies.

In the age-adjusted model, dietary fiber intake was significantly associated with a 16 percent lower risk of colorectal cancer in the highest quintile compared with the lowest. This association was attenuated slightly but still remained statistically significant after adjusting for nondietary risk factors, multivitamin use, and total energy intake. Additional adjustment for dietary folate intake further weakened the association. In the final model, which further adjusted for other dietary factors, such as red meat, total milk and alcohol intake, only a nonsignificant weak inverse association was found. Fiber intake from cereals, fruits, and vegetables was not associated with risk of colorectal cancer.

“Although high dietary fiber intake may not have a major effect on the risk of colorectal cancer, a diet high in dietary fiber from whole plant foods can be advised because this has been related to lower risks of other chronic conditions such as heart disease and diabetes,” the researchers write.

WASHINGTON — In December, the American Association of Colleges of Nursing (AACN) released preliminary survey data showing that enrollment in entry-level baccalaureate nursing programs increased by 13.0 percent from 2004 to 2005. Though this increase is welcome, surveyed nursing colleges and universities denied 32,617 qualified applications due primarily to a shortage of nurse educators.

According to research conducted by Peter Buerhaus, PhD, RN, FAAN, from Vanderbilt University, enrollments in nursing programs would have to increase by at least 40 percent annually to replace those nurses expected to leave the workforce through retirement.

Given the demands of today’s healthcare system, the greatest need in the nursing workforce is for nurses prepared at the baccalaureate and higher degree levels. With the federal Health Resources and Services Administration calling for baccalaureate preparation for at least two-thirds of the nursing workforce, the evidence clearly shows that higher levels of nursing education are linked with lower patient mortality rates, fewer errors, and greater job satisfaction among RNs.

However, access to professional nursing education is becoming more difficult. AACN’s preliminary findings show that 32,617 qualified applications to entry-level baccalaureate programs were not accepted in 2005 based on responses from 432 schools. The primary barriers to accepting all qualified students at nursing colleges and universities continue to be insufficient faculty, clinical placement sites, and classroom space.

To address these issues, AACN has focused its advocacy efforts on increasing funding for existing Nursing Workforce Development programs administered by the federal Division of Nursing and shaping new legislation to support faculty development and enrollment growth.

Earlier this year, AACN secured a new funding stream for doctoral nursing education through the Department of Education’s Graduate Assistance in Areas of National Need (GAANN) program, which will help to address the faculty shortage. AACN successfully lobbied to have nursing identified as an area of national need for the first time through the GAANN program.

Further, AACN has worked with colleagues in the healthcare community to introduce new legislation to address the faculty shortage and other nursing school resource constraints, including the Nurse Education, Expansion and Development Act and the Nurse Faculty Education Act.

NEW YORK — The Foundation for Clinical Research in Inflammatory Bowel Disease launched myIBD.org, a new information site designed for those concerned about inflammatory bowel disease (IBD), the collective term for Crohn’s disease, ulcerative colitis, and indeterminate colitis. IBD affects more than 1 million Americans and is a chronic, lifelong disease that has no known cause or cure. “We want patients and their caregivers to be able to access the best information available from the leading authorities on IBD,” said Jane Present, co-founder and executive director of the Foundation for Clinical Research in IBD. “That’s why we worked with members of our scientific advisory committee, which includes IBD specialists and thought leaders from the country’s leading institutions, to develop the content for myIBD.org.” The patient education section of the site includes an overview of IBD and the therapies used to treat the disease. In addition, myIBD.org includes transcripts of the Foundation’s Advances in Inflammatory Bowel Disease patient education programs, which it has hosted in more than 70 cities throughout the United States. An “Ask the Specialist” section also provides a more in-depth look at questions that IBD patients and their caregivers may have. In addition to providing information to patients, the Foundation for Clinical Research in IBD is striving to enhance the array of effective medications available to treat IBD, as well as to encourage young gastroenterologists to pursue clinical careers in IBD. Therefore, myIBD.org contains information devoted to clinicians that outlines the opportunities available through the Foundation. Finally, the site will include information about current clinical trials and how patients can participate. MyIBD.org is published by the nonprofit organization the Foundation for Clinical Research in IBD and underwritten through unrestricted educational grants from Abbott Laboratories, Centocor, Inc., Procter & Gamble Pharmaceuticals, Salix Pharmaceuticals, Inc., and Shire USA Pharmaceuticals Inc. To view the Web site, visit www.MyIBD.org. 

Source: Foundation for Clinical Research in Inflammatory Bowel Disease

WHITE RIVER JUNCTION, Vt. — A recent study in The American Journal of Gastroenterology revealed that patterns in diet may affect the development of colorectal adenomas, or precancerous polyps of the colon. In this study, more than 1,500 patients underwent baseline colonoscopy to remove existing polyps. They were then given a survey about their diet. After a period of one year and then four years later, the group underwent follow-up colonoscopies to determine if any polyps had returned. Those who had consumed diets higher in processed meats showed a greater risk of developing recurrent colorectal adenomas. Those with diets high in certain white meats, like chicken, were less prone to this risk. “Our results are consistent with prior studies that suggest certain dietary factors may be important in the development of colon polyps and cancer,” states Douglas Robertson, MD, MPH, lead researcher of the study and chief of the section of gastroenterology at the VA Medical Center in White River Junction, Vt. Previous studies have explored whether fiber intake effects the growth and development of colorectal adenomas and cancer; however, this study found no significant evidence to suggest an association. The same was determined for dietary intake of fat and red meat. According to the National Cancer Institute and the National Institutes of Health, colorectal cancer is the third most common type of non-skin cancer in men (after prostate cancer and lung cancer) and in women (after breast cancer and lung cancer). It is the second leading cause of cancer death in the United States, with more than 57,000 people dying from colorectal cancer each year. Robertson is also assistant professor of medicine at Dartmouth Medical School. He is currently clinical director of the Vitamin D/Calcium Polyp Prevention Study, a large multi-center trial that aims to determine whether intake of vitamin D and/or calcium supplements can reduce adenoma recurrence in those with a history of colon adenomas.

Source: Blackwell Publishing

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