Far Eastern University: Evidence Based Nursing

FAR EASTERN UNIVERSITY
EVIDENCE BASED NURSING
I. Clinical Question
Among virbrio cholerae serogroup 01 which is the main cause of cholera and the newly discovered strain vibrio
cholerae 0139 (year: 2009) which are both causative agents of water-borne disease “CHOLERA” which among this
strains has more virulent potential on human patients?
II. Citations
Journal: Characterization of potentially virulent non-O1/non-O139 Vibrio cholerae strains isolated

from human patients
Clinical Microbiology and Infection Vol. 16 Issue 1 pp. 62-67
http://www3.interscience.wiley.com/journal/122387701/abstract (www.medworm.com)
O. P. de Melo Neto, Moraes Rego and N.C Leal
May 18, 2009 (published online)
III. Study Characteristics
 Patients included
Population: The study has used seven bacteria strains (7) from the original strain vibrio cholerae serogroup 01 from non-
specific isolated patients.
Sample: The seven V. cholerae O26 strains and the non-typable strain belong to the collection of the National Reference
Laboratory for Cholera and Enteric Diseases at the Instituto Oswaldo Cruz (IOC), Rio de Janeiro, and have been
previously described. Clinical strain O1, classical biotype (569B), and environmental strain O1, El Tor biotype (63), also
available at the collection, were used as controls.
 Interventions compared
Vibrio Cholerae Serogroup 01 vs. Vibrio Cholerae 0139 which strain has more virulent potential on human
patients.
 Outcomes monitored
Outcome of the study was monitored using a Control Group which is clinical isolates of non-O1/non-O139
V. cholerae, collected during cholera outbreaks in Brazil. A PCR-based approach has previously detected in these strains
several virulence genes derived from the prophage and generally associated with pathogenic strains.
 Does the study focus on a significant problem in clinical practice?
Yes, the study focuses on a significant problem in a clinical practice especially in a country like ours which are
bound by bodies of waters and which are usually route of calamities like typhoons which usually causes severe flooding in
some parts of the country.
“CHOLERA” is a water borne disease caused by Vibrio Cholerae which causes acute intestinal infection caused
by ingestion of food or water contaminated with the bacteria. It has a short incubation period, from less than one day to
five days, and produces an enterotoxin that causes copious, painless, watery diarrhoea that can quickly lead to severe
dehydration and death if treatment is not promptly given. Vomiting also occurs in most patients
Since “cholera” is at time during this season, proper knowledge and information regarding this disease is a
preventive factor in preventing this deadly epidemic. And by knowing the strain of cholera infected to a certain patient the
right type of care can be implemented to assure recovery from the infection.
IV. Methodology/ design
 Methods used
The researcher used a qualitative study and employed a control group on vibrio cholerae strains in observing the
two strains of the bacteria.
 Design
The study is descriptive and a longitudinal design was used and repeated measurement was collected
prospectively on each strain, agglutination test, DNA and PCR extraction was done on both strains of the bacteria, cholera
toxin analysis was also done to confirm the above tests.
 Setting: Rio de Janeiro, Brazil
 Data sources
Data gathered are from primary and secondary sources since the data are directly observed and studied by the
researcher and additional information’s and factual data’s regarding the bacteria was obtained from National Reference
Laboratory for Cholera and Enteric Diseases
 Subject selection
Seven bacteria strains (7) from the original strain vibrio cholerae serogroup 01 from non-specific isolated patients.
The seven V. cholerae O26 strains and the non-typable strain of vibrio cholerae. Clinical strain O1, classical
biotype (569B), and environmental strain O1, El Tor biotype (63), also available at the collection, were used as subjects of
the study.
 Has the original study been replicated?
The study has not been replicated yet but was subjected to major edition prior to online publishing. The study was
made to public on Journals and Books on December 30, 2008 it was revised by the same authors on February 11,
2009 and was edited by Dr. P. Tassios of Departamento de Microbiologia, Centro de Pesquisas Aggeu.
 What were the risks and benefits of the nursing action or intervention tested in the study?
Risk in the study is; “possible outbreak” if the strains are not well secured.
There is a risk on the researcher’s health handling with the specimens.
Benefits from the study are new information and data’s regarding cholera, how to prevent it and what are the
appropriate management on different strains of cholera in order to secure the quick recovery of a patient infected with a
certain strain of cholera.
V. Results of the study
As based from the PCR-based approach which was previously detected in these strains several virulence genes
derived from the prophage and generally associated with pathogenic strains. Here, the presence of the O1-specific wbeN
gene was investigated through PCR and found to be restricted to strain 17155, as well as one of the O139 strains, although
neither strain was recognized by O1-specific antisera. The same two isolates were the only strains able to express the
cholera toxin in culture, assayed by western blotting. They also possessed four repeats of the heptanucleotide TTTTGAT
upstream of the ctxAB genes encoding the cholera toxin.
The remaining strains possessed only two intact repeats, whereas pathogenic O1 possessed four to six repeats. To
define their evolutionary relationships, selected 16S–23S intergenic rRNA spacer regions were sequenced from the
various strains and the resulting sequences used to build phylogenetic trees. Strains 01 and 0139 always clustered with
control O1 strains, whereas the remaining strains clustered separately. These results confirm that, despite their
serological phenotype difference, these two strains are genotypically related to both strains and potentially able to produce
epidemic cholera.
VII. Applicability
 Does the study provide a direct enough answer to your clinical question in terms of type of patients intervention and
outcome?
Yes, the study provides a direct answer on the clinical question in which the results of the study confirms that both
strains vibrio cholerae serotype 01 and the new strain vibrio cholerae 0139 even though they have different phenotype
they are genotypically related which means they can both produce epidemic cholera on human patients.
 Is it feasible to carry out the nursing action in the real world?
Yes, it is feasible to carry out the nursing action, since the disease is actual and happening in reality. Ideas,
information’s and factual data’s from the study including independent nursing action are beneficial and helpful in
addressing the needs and providing quality care to the patient.
VIII. Reviewers Conclusion
The study conducted both on Cholera and its new strains needs more revision and updated facts and information in order
to strengthen the initial findings and support the initial output of the study.
The study also should be duplicated to obtain and yield more information regarding the studies, and verify data’s gathered
if it’s useful and factual in strengthening the foundation of the initial findings, output and assessment of the initial study.
Outputs gathered must be collaborated on nursing process, nursing practice, nursing administration and nursing research
in which will be more helpful on nursing students and health care practitioners.
a) Safety & Competence
In regards to safety, independent nursing action in addressing cholera patients suffering from different strains must be
based on factual information’s and reliable data’s to secure the quick recovery of the patient and to prevent alleviating the
condition of the patient.
Prior to knowing the competency, we should ask ourselves first, “What is the role of the primary health care provider
(HCP). Competency is measured by how appropriate, how effective and how efficient the primary health care to be
delivered or rendered. With these we can conclude that a health care provider is competent enough so long as he/she is
equipped with the right knowledge and skill needed to perform nursing action.
b) Acceptability & Effectiveness/Appropriateness
The data’s and information from the study are well accepted in the medical field since it is actual and existing, thus
interventions to be done must be based on well accepted information’s and data’s regarding cholera and it’s different
strain to assure the health of the patient and prevent further aggravation of the client’s case.
c) Accessibility
Data’s and updated information’s regarding the study are readily accessible thru the net or books, independent nursing
management and action regarding the disease must be based on clear and factual information’s regarding cholera and it’s
different strain O1 and 0139 to assure the patient that the right care is given to him/her.

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FAR EASTERN UNIVERSITY

EVIDENCE BASED NURSING

Journal: Characterization of potentially virulent non-O1/non-O139 Vibrio cholerae strains isolated

III. Study Characteristics

 Does the study focus on a significant problem in clinical practice?

IV. Methodology/ design

 Setting: Rio de Janeiro, Brazil

 Has the original study been replicated?

V. Results of the study

 Is it feasible to carry out the nursing action in the real world?

VIII. Reviewers Conclusion

a) Safety & Competence

b) Acceptability & Effectiveness/Appropriateness

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