Conclusions: An integrated 6-mo prognostic tool was developed and validated for the HD population. The instrument may be of value for researchers and clinicians to improve end-of-life care by providing more accurate prognostic information.

Intra-dialytic, low-intensity progressive strength training was safe and effective among maintenance dialysis patients. Further studies are needed to establish the generalizability of this strength training program in dialysis patients.

Objective. To study the effect of fluoxetine (FL) and amitriptyline (AM), alone and in combination, in patients with fibromyalgia (FM).Methods. Nineteen patients with FM completed a randomized, double-blind crossover study, which consisted of 4 6-week trials of FL (20 mg), AM (25 mg), a combination of FL and AM, or placebo. Patients were evaluated on the first and last day of each trial period. Outcome measures included a tender point score, the Fibromyalgia Impact Questionnaire (FIQ), the Beck Depression Inventory (BDI) scale, and visual analog scales PAS) for global well-being (1 completed by the physican and 1 by the patient), pain, sleep trouble, fatigue, and feeling refreshed upon awakening.Results. Both FL and AM were associated with significantly improved scores on the FIQ and on the VAS €or pain, global well-being, and sleep disturbances. When combined, the 2 treatments worked better than either medication alone. Similar, but nonsignificant, improvement occurred in the BDI scale, the physician global VAS, and the VAS for fatigue and feeling refreshed upon awakening. Trends were less clear for the tender point score.Conclusion. Both FL and AM are effective treatments for FM, and they work better in combination than either medication alone.Clinical trials of medications for the treatment of fibromyalgia (FM) have demonstrated modest or little efficacy. Tricyclic and tetracyclic "antidepressant" drugs

Receipt of fluconazole and central venous catheter exposure were associated with an increased risk of BSI due to non-albicans Candida species, and total parenteral nutrition was associated with a decreased risk of BSI due to non-albicans Candida species, compared with BSI due to C. albicans. Patients without characteristics of infection due to non-albicans Candida species might benefit from empirical antifungal therapy with fluconazole.

Abstract/SummaryObjective-To compare different statistical models for combining N-of-1 trials to estimate a population treatment effect.Study Design and Setting-Data from a published series of N-of-1 trials comparing amitriptyline therapy and combination treatment (amitriptyline + fluoxetine ) were analyzed to compare summary and individual participant data meta-analysis, repeated measures models, Bayesian hierarchical models, single-period, single-pair and averaged outcome crossover models.Results-The best fitting model included a random intercept (response on amitriptyline) and fixed treatment effect (added fluoxetine). Results supported a common, uncorrelated within-patient covariance structure that is equal between-treatments and across patients. Assuming unequal withinpatient variances, a random effects model was favored. Bayesian hierarchical models improved precision and were highly sensitive to within-patient variance priors.Conclusion-Optimal models for combining N-of-1 trials need to consider goals, data sources, and relative within and between patient variances. Without sufficient patients, between-patient variation will be hard to explain with covariates. N-of-1 data with few observations per patients may not support models with heterogeneous within-patient variation. With common variances, models appear robust. Bayesian models may improve parameter estimation but are sensitive to prior assumptions about variance components. With limited resources, improving within-patient precision must be balanced by increased participants to explain population variation.

Cardiovascular disease is a leading cause of death among kidney transplant recipients. Anemia, a risk factor for cardiovascular complications among patients with chronic kidney disease, has not been well characterized in kidney transplant recipients. We performed a retrospective cohort study of the prevalence of and factors associated with anemia among 240 patients who underwent kidney transplantation at our institution. The mean hematocrit (Hct) rose from 33% at 1 month after transplantation to 40% at 12 months after transplantation. The proportion of patients with Hct < 36% was 76% at transplantation and 21% and 36%, 1 year and 4 years after transplantation, respectively. Six months after transplantation, women had higher likelihood (OR = = 3.61) of Hct < 36%, while higher Hct at 3 months (OR = = 0.67 for 1% higher Hct) and diabetes (OR = = 0.14) were associated with a lower likelihood of Hct < 36%. Similar associations were seen 12 months after transplantation. Even among patients with Hct < 30%, only 36% had iron studies, 46% received iron supplementation and 40% received recombinant human erythropoietin. Awareness of factors associated with a lower Hct may prompt better anemia screening and management, potentially improving cardiovascular outcomes among kidney transplant recipients.

The susceptibility trends for the species of the Bacteroides fragilis group against various antibiotics from 1997 to 2004 were determined by using data for 5,225 isolates referred by 10 medical centers. The antibiotic test panel included ertapenem, imipenem, meropenem, ampicillin-sulbactam, piperacillin-tazobactam, cefoxitin, clindamycin, moxifloxacin, tigecycline, chloramphenicol, and metronidazole. From 1997 to 2004 there were decreases in the geometric mean (GM) MICs of imipenem, meropenem, piperacillin-tazobactam, and cefoxitin for many of the species within the group. B. distasonis showed the highest rates of resistance to most of the ␤-lactams. B. fragilis, B. ovatus, and B. thetaiotaomicron showed significantly higher GM MICs and rates of resistance to clindamycin over time. The rate of resistance to moxifloxacin of B. vulgatus was very high (MIC range for the 8-year study period, 38% to 66%). B. fragilis, B. ovatus, and B. distasonis and other Bacteroides spp. exhibited significant increases in the rates of resistance to moxifloxacin over the 8 years. Resistance rates and GM MICs for tigecycline were low and stable during the 5-year period over which this agent was studied. All isolates were susceptible to chloramphenicol (MICs < 16 g/ml). In 2002, one isolate resistant to metronidazole (MIC ‫؍‬ 64 g/ml) was noted. These data indicate changes in susceptibility over time; surprisingly, some antimicrobial agents are more active now than they were 5 years ago.Pathogens of the Bacteroides fragilis group are the anaerobic pathogens that are the most frequently isolated from blood and abscesses. They are also among the most antibiotic-resistant isolates in anaerobic and mixed infections (21). Susceptibility to antibiotics varies considerably among the species of the group, yet most clinical laboratories do not routinely determine the species of the organism or test the susceptibilities of any anaerobic isolates, including those in the B. fragilis group, due to technical difficulties surrounding Bacteroides susceptibility testing (21). Consequently, the treatment of anaerobic infections is selected empirically, based on published reports on patterns of susceptibility (14,15,19,20). Therefore, the importance for reference laboratories to provide information on the patterns of susceptibility of the species within the group is important clinically. For over 20 years we have conducted a national survey on the susceptibility patterns of these important pathogens and our laboratory at Tufts New England Medical Center served as a reference center for the storage and testing of Bacteroides clinical isolates. We undertook this analysis to determine the susceptibility trends of the various species, using data from 1997 to 2004 for 5,225 isolates referred by 10 geographically diverse medical centers distributed throughout the United States. Bacterial isolates. Nonduplicate clinical isolates of the B. fragilis group were referred for susceptibility testing to the Special Studies Laboratory at New England Medical Center by ...

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