Francisella tularensis in Swedish predators and scavengers.

Tularaemia is a zoonotic disease, in Europe caused by Francisella tularensis subsp. holarctica. Many lagomorphs and a variety of small rodents are wildlife species prone to develop clinical disease, while predators and scavengers are relatively resistant and may serve as sentinels. Blood samples from 656 Swedish wild predators and scavengers were serologically investigated using slide agglutination and microagglutination. In the slide agglutination test, 34 seropositive animals were detected, and they were found among all species investigated: brown bear (Ursus arctos), Eurasian lynx (Lynx lynx), raccoon dog (Nyctereutes procyonoides), red fox (Vulpes vulpes), wild boar (Sus scrofa), wolf (Canis lupus) and wolverine (Gulo gulo). Due to haemolysis the microagglutination test was more difficult to read at low titres, and only 12 animals were classified as seropositive. F. tularensis subsp. holarctica was detected by a polymerase chain reaction in lymphatic tissues of the head in one brown bear, one red fox and one wolf. The significance of this finding regarding possible latency of infection is not clear. In conclusion, the results of this study indicate that all predator and scavenger species included in this study may serve as sentinels for tularaemia in Sweden. Their role as reservoirs is unclear.

Minimal unilateral peak nasal inspiratory flow correlates with patient reported nasal obstruction.

BACKGROUND: Nasal septoplasty is a common surgical procedure, but a significant number of patients report equal, or some even worsened, symptom load postoperatively. Rhinologists struggle to find objective tests that adequately reflects disease burden. This study aimed to evaluate the correlation between the PNIF measurement of the most obstructed side with patient reported outcomes. METHODS: Bilateral and unilateral PNIF measurements were performed before and after topical decongestion in 528 patients scheduled for surgery due to nasal obstruction. Subjective outcomes were measured using Nasal Obstruction VAS and SNOT-22 with subdomains. Correlations between subjective and objective measurements were calculated and further explored using multivariate regression analyses. RESULTS: Significant negative correlations between PNIF and patient reported outcomes were found. Both bilateral and minimal unilateral PNIF correlations with NO-VAS were equal and stronger than correlations with SNOT-22 including subdomains concerning problems with nasal obstruction. Minimal unilateral PNIF did not show statistically significant gender difference. Topical decongestion decreased statistical correlations. CONCLUSIONS: The minimal unilateral PNIF shows a statistically significant but weak negative correlation with preoperative patient reported nasal obstruction, and values do not differ between genders. Clinical evaluation of patients presenting complaints of nasal obstruction could be supported by minimal unilateral PNIF.

One-year results of the SCANDIV randomized clinical trial of laparoscopic lavage versus primary resection for acute perforated diverticulitis.

BACKGROUND: Recent randomized trials demonstrated that laparoscopic lavage compared with resection for Hinchey III perforated diverticulitis was associated with similar mortality, less stoma formation but a higher rate of early reintervention. The aim of this study was to compare 1-year outcomes in patients who participated in the randomized Scandinavian Diverticulitis (SCANDIV) trial. METHODS: Between February 2010 and June 2014, patients from 21 hospitals in Norway and Sweden presenting with suspected perforated diverticulitis were enrolled in a multicentre RCT comparing laparoscopic lavage and sigmoid resection. All patients with perforated diverticulitis confirmed during surgery were included in a modified intention-to-treat analysis of 1-year results. RESULTS: Of 199 enrolled patients, 101 were assigned randomly to laparoscopic lavage and 98 to colonic resection. Perforated diverticulitis was confirmed at the time of surgery in 89 and 83 patients respectively. Within 1 year after surgery, neither severe complications (34 versus 27 per cent; P = 0·323) nor disease-related mortality (12 versus 11 per cent) differed significantly between the lavage and surgery groups. Among the 144 patients with purulent peritonitis, the rate of severe complications (27 per cent (20 of 74) versus 21 per cent (15 of 70) respectively; P = 0·445) and disease-related mortality (8 versus 9 per cent) were similar. Laparoscopic lavage was associated with more deep surgical-site infections (32 versus 13 per cent; P = 0·006) but fewer superficial surgical-site infections (1 versus 17 per cent; P = 0·001). More patients in the lavage group underwent unplanned reoperations (27 versus 10 per cent; P = 0·010). Including stoma reversals, a similar proportion of patients required a secondary operation (28 versus 29 per cent). The stoma rate at 1 year was lower in the lavage group (14 versus 42 per cent in the resection group; P < 0·001); however, the Cleveland Global Quality of Life score did not differ between groups. CONCLUSION: The advantages of laparoscopic lavage should be weighed against the risk of secondary intervention (if sepsis is unresolved). Assessment to exclude malignancy (although uncommon) is advised. Registration number: NCT01047462 ( http://www.clinicaltrials.gov).

A survey of hospital policies on verbal orders.

The authors present the results of surveys of directors of nursing and directors of pharmacy on the types and extensiveness of the policies their institutions have implemented to control the use of verbal and telephone orders. One hundred hospitals were selected at random from 874 hospitals meeting the following criteria: 250 beds or larger, general medical surgical, short stay, and nongovernmental. The survey results demonstrated that a significant number of hospitals are attempting to regulate the use of verbal and telephone orders. However, only 35.5% of the hospitals surveyed have any policies that prohibit the use of verbal orders when the physician is physically present on the unit where the order is given, in non-emergency and non-bedside procedure situations. Relative to the above policy, directors of nursing state that this policy is followed 41.1% of the time and directors of pharmacy in the same institutions state that the policy is adhered to 11.1% of the time. In addition to the survey, the authors explain situations that may serve as a source of medication errors when using verbal or telephone orders. They also offer several precautions to take when the use of verbal and telephone orders is absolutely necessary.

Joint pharmacy/nursing procedure for monitoring unit dose distribution and unadministered doses.

This article describes a procedure that uses a multidisciplinary approach to quality assurance in a unit-dose distribution system. The procedure described here uses an assigned nurse and one member of the pharmacy staff (pharmacist, technician/intern) on each nursing unit to check the physical contents of medication cassettes as well as compare pharmacy patient profiles with nursing medication administration records. In examining data from a 184 calendar day period, there was an average of 822 doses of medication per day, including IV admixtures and piggybacks, checked using this system. The time spent in the checking process was approximately 40 minutes per day for each of the three pharmacy staff members performing the check. The average daily census during this period was 60 patients, located on two medical/surgical nursing units, a combined short-procedure unit/detox unit, and an eight-bed critical care unit. The procedure presented also includes a mechanism for the nursing staff to easily document unadministered doses in a manner that provides the pharmacy department with this information. The procedure described makes it extremely difficult for certain types of medication errors to extend beyond a 24-hour period. It also controls missing doses. We found during the 184-day period that only 12 doses were reported missing from the cassettes after the check process. The low number of missing doses reported can be attributed to the fact that the assigned nurse and member of the pharmacy staff verify the presence of a 24-hour supply of medication.