A foodborne outbreak of campylobacteriosis at a wedding - Melbourne, Australia, 2022.

Campylobacter is the most common bacterial cause of foodborne gastroenteritis in Australia; however, outbreaks caused by the pathogen are relatively uncommon. In March 2022, the Victorian Department of Health was notified of a gastrointestinal illness in 20 guests following attendance at a wedding reception. Two of these individuals were notified with laboratory-confirmed campylobacteriosis, and an investigation was undertaken to identify the source of the infection and implement strategies to prevent further illness. A case-control study was conducted to determine the likely source of infection. Cases were defined as attendees of the wedding reception, with onset of diarrhoea and/or abdominal cramping 1-10 days after attending the function. Controls were randomly selected from the remaining list of non-ill guests. Cases and controls were interviewed using a standardised, menu-based questionnaire. Food preparation processes were documented, and food samples collected. A total of 29 wedding guests met the case definition. Cases reported onset of illness 2-5 days following the wedding and major symptoms included abdominal cramping (100%), diarrhoea (90%), headache (79%), and fever (62%). Two cases were hospitalised, one with ongoing secondary neurological sequelae. Illness was significantly associated with consumption of a duck breast brioche canapé containing duck liver parfait (odds ratio = 2.85; 95% confidence interval: 1.03-7.86). No leftover food samples were available for testing. The investigation found that the duck canapé was the likely vehicle of infection. Consistent with the literature on Campylobacter transmission, it is likely that inadequate cooking of the duck liver for the parfait was the contributing factor that led to illness. This highlights the risks posed by undercooked poultry dishes, and shows that education of food handlers remains a priority.

Mixed methods systematic review of the literature base exploring working alliance in the chiropractic profession.

BACKGROUND: The construct of working alliance has been used to operationalise the patient-clinician relationship. Research evidence from the rehabilitation literature has established an association between the construct and several patient outcomes. The aim of this systematic literature review was to study working alliance in the chiropractic discipline. METHOD: This review followed a mixed method systematic review methodology: EBSCO (The Allied and Complementary Medicine Database), EBSCO (MEDLINE), EBSCO PsycINFO, Web of Science Core Collection, Chiro index, and grey literature were searched for quantitative, qualitative, and mixed methods studies on 17th March 2021. Qualitative appraisal was conducted using the Mixed Methods Appraisal Tool, version 2018. The qualitative component was synthesised via thematic synthesis and explored patients' and chiropractors' perceptions of the nature and role of working alliance. The quantitative component was synthesised via narrative synthesis to examine how the construct has been measured in research and what its effect on clinical outcomes and patient satisfaction is. The findings were integrated in the discussion section. RESULTS: Thirty studies were included. The qualitative component found that both patients and chiropractors consider working alliance as a key factor in the treatment journey. The findings illustrated that the construct includes the bond between a patient and a chiropractor which is underpinned by trust and attentiveness to patients' needs, values and preferences. Qualitative data also suggested that strong working alliance has the potential to improve patients' adherence to treatment and that it is characterised by ongoing negotiation of expectations about the goals of care and the tasks involved in the treatment plan. The quantitative component highlighted that even though working alliance is relevant to the chiropractic discipline, very few studies have quantitatively measured the construct and its effect. CONCLUSION: The findings of this review emphasise the subjective importance of working alliance in the chiropractic clinical encounter. However, there were not enough homogenous studies measuring the effect of working alliance on clinical outcomes and patient satisfaction to conduct a meta-analysis. Future research should focus on evaluating potential direct and mediated effects on patient outcomes.