Reduction of inoculated Salmonella cocktail in ground turkey and turkey breasts using Lactobacillus-based intervention.

Lactic acid bacteria (LAB) have been shown to be inhibitory toward various pathogenic bacteria during refrigerated storage of ground beef samples and in subprimals. In this study, the effectiveness of a combination of 4 strains of Lactobacillus at reducing Salmonella in turkey products was evaluated to improve the final safety of the product. Turkey breasts (hot and chilled) were inoculated with a 3-strain Salmonella cocktail (Typhimurium ATCC 14028, Enteritidis PT 13 NVSL 96-18535, and Heidelberg 3347-1 Sheldon) and then treated with 1 × 10(6 )cfu/cm(2) of a Lactobacillus-based intervention comprising NP51, NP35, NP3, and NP7 (Lactiguard, Nutrition Physiology Corp., Kansas City, MO). The turkey breasts were stored at either 5°C to simulate refrigerated storage and sampled on d 0, 1, 2, and 3 or at 37°C to simulate hot carcass applications and sampled at h 0, 2, and 4. Additionally, ground turkey was inoculated with a 3-strain Salmonella cocktail, treated with 1 × 10(6 )cfu/g of the LAB intervention, and stored at 5°C with sampling on d 0, 1, 2, and 3. The reduction of Salmonella in the turkey breasts stored at 5°C treated with Lactobacillus was 2 log (P < 0. 05) compared with the control turkey breasts after d 2. Salmonella in the turkey breasts held at 37°C was reduced by 1.5 log (P < 0.05) by h 2 and 2 log (P < 0.05) by h 4. The Salmonella in the ground turkey held at 5°C using the LAB exhibited a 2 log (P < 0. 05) reduction compared with the control after d 1. These results show that the addition of a Lactobacillus-based treatment in turkey products significantly reduces Salmonella during storage.

Measurement of Perceived and Technical Quality of Care for Depression in Racially and Ethnically Diverse Groups.

Measurement of patient satisfaction is now considered essential for providing patient centered care and is an important tool for addressing health care disparities. However, little is known about how ethnically and racially diverse (ERD) groups differ in how they perceive quality, and widely used instruments for measuring perceived quality give little attention to cultural elements of care. This study examined the relationship between the culturally determined beliefs and expectations of four ERD groups (African Americans, Latinos, Portuguese-speakers, and Haitians, total N = 160) and the technical quality of treatment for depression provided in four "culturally-specific" primary care clinics. Using data from the Experiences of Care and Health Outcomes survey, chart reviews and focus groups, the study addressed a set of questions related to the psychometric properties of perceived care measures and the technical quality of care. The groups differed in preferred cultural elements except all preferred inclusion of religion. They did not differ in overall perceived quality. Technical quality was higher for Portuguese and Haitians than for African Americans and Latinos. Implications of group differences for measuring quality are discussed.

Assessment of Medicaid managed behavioral health care for persons with serious mental illness.

OBJECTIVES: This five-site study compared Medicaid managed behavioral health programs and fee-for-service programs on use and quality of services, satisfaction, and symptoms and functioning of adults with serious mental illness. METHODS: Adults with serious mental illness in managed care programs (N=958) and fee-for-service programs (N=1,011) in five states were interviewed after the implementation of managed care and six months later. After a multiple regression to standardize the groups for case mix differences, a meta-analysis using a random-effects model was conducted, and bioequivalence methods were used to determine whether differences were significant for clinical or policy purposes. RESULTS: A significantly smaller proportion of the managed care group received inpatient care (5.7 percent compared with 11.5 percent). The managed care group received significantly more hours of primary care (4.9 compared with 4.5 hours) and was significantly less healthy. However, none of these differences exceed the bioequivalence criterion of 5 percent. Managed care and fee for service were "not different but not equivalent" on 20 of 34 dependent variables. Cochrane's Q statistic, which measured intersite consistency, was significant for 20 variables. CONCLUSIONS: Managed care and fee-for-service Medicaid programs did not differ on most measures; however, a lack of sufficient power was evident for many measures. Full endorsement of managed care for vulnerable populations will require further research that assumes low penetration rates and intersite variability.

Cardiovascular effects of antihypertensive polar and neutral renomedullary lipids.

Two antihypertensive lipids can be extracted from fresh renal medulla. One is polar (the antihypertensive polar renomedullary lipid, or APRL) and the other is nonpolar (the antihypertensive neutral renomedullary lipid, or ANRL). APRL and ANRL differ in their biologic activities: APRL in bolus intravenous injections causes a very rapid decline in the arterial pressure (AP) while ANRL, after a lag of 2 minutes, causes a slower decline in AP. APRL increases heart rate and sympathetic activity. ANRL decreases heart rate and sympathetic activity. ANRL appears to convert to APRL, under certain in vitro circumstances, suggesting that the structure of the two molecules is related. ANRL and APRL appear in the renal venous effluent after unclipping; biologically, ANRL seems dominant. The renal venous effluent of the unclipped isolated kidney lowers the HR and sympathetic activity of the normal rat. Unclipping degranulates the renomedullary interstitial cells (RIC). The antihypertensive effect of unclipping appears due to the secretion of ANRL and APRL by the kidney. It is concluded that ANRL seems to be the antihypertensive hormone of the RIC.

Anesthetic considerations.

Proper anesthetic care begins with a thorough preoperative assessment. This can rarely be performed in the acute trauma victim. Specific disease states in the cardiovascular, endocrine, hematologic, and respiratory systems are considered here. Substance abuse is also discussed. A better understanding of the interactions between pre-existing disease and traumatic injury should result.

Disaster management. Organizations and academic perspective.

The world has to cope with the results of an increasing number of disasters. If the planning and preparation for these disasters are to be effective, then national and international organizations are necessary to integrate the sources of advice and relief. Studies of disaster management have consistently highlighted coordination of resources as an essential element of effective response. These organizations, both governmental and voluntary, aim to do just that, and awareness of them and their work will add support.

The determination of busulphan in dissolution samples by flow injection analysis.

A robust colourimetric flow injection analysis (FIA) procedure is described for the determination of busulphan in dissolution samples of a 2 mg tablet formulation. The sample solution is injected directly into a reagent stream containing 4-(4-nitrobenzyl)pyridine/potassium hydrogen phthalate. An on-line heating stage allows the formation of a coloured pyrridinium salt species, which following stabilisation is detected spectrophotometrically at 570 nm. The method has been fully validated and is linear over the concentration range 0.004-0.024 mg of busulphan ml(-1). The method can also been applied to uniformity of content and bulk assay testing.

The determination of pentavalent antimony in sodium stibogluconate in a pharmaceutical formulation by flow injection analysis.

A flow injection analysis (FIA) procedure is described for the determination of pentavalent antimony (Sb5+) in the drug, sodium stibogluconate, in a parenteral pharmaceutical formulation. The sample solution is injected directly into a carrier stream of iodide ion which is then mixed with an acid stream in situ. Sb5+ is determined by the redox reaction with acidified iodide to liberate iodine, which is monitored spectrophotometrically at 350 nm. The closed conditions prevent interference from atmospheric oxygen and the rapid reaction time assists in minimizing interference from side reactions. The use of tartaric acid as a solvent for sample and standard solutions ensures obedience of Beer's law over the Sb5+ concentration range 0.01-0.2% (w/v). The method is specific for the higher oxidation state in an ionic mixture of Sb5+ and Sb3+, and has been fully validated for use in a pharmaceutical preparation. Assuming absence of matrix interference it is applicable to Sb5+ from other sources and should be applicable to other reducible ionic species.

Early sibling attachment.

A sample of 30 predominantly three- and four-year-old siblings were videotaped during their first meeting with a new sibling at the time of the mother's discharge from the hospital. The first five minutes of interaction were divided into 20, 15-second intervals, and each interval was coded for the presence or absence of 28 behaviors believed to be related to the early attachment process. The exploration behaviors of siblings showed considerable uniformity. The sibling's age, sex, or participation in sibling preparation classes produced no marked differences in behavior. Recommendations are made for further research.

Multisite study of an evidence-based practice to reduce seclusion and restraint in psychiatric inpatient facilities.

OBJECTIVE: This federally funded study examined implementation and outcomes of the Six Core Strategies for Reduction of Seclusion and Restraint (6CS) in 43 inpatient psychiatric facilities. METHODS: A prototype Inventory of Seclusion and Restraint Reduction Interventions (ISRRI) tracked fidelity over time. Outcome measures--seclusion and restraint events as percentages of total inpatient population and seclusion and restraint hours as percentages of total inpatient hours--conformed to licensed Behavioral Health Performance Measurement System specifications. Independent variables were facility and patient characteristics. Facilities were classified into five implementation types based on ISRRI scores: stabilized (N=28), continued (N=7), decreased (N=5), discontinued (N=1), or never implemented (N=2). For the stabilized group, linear modeling and random-effects meta-analysis compared the contribution of individual facilities to an overall effect. Subgroup analyses explored relationships between facility characteristics and outcomes. Dose-effect analysis tested the hypothesis that the stabilized group would have more positive outcomes. RESULTS: Overall, the stabilized group reduced the percentage secluded by 17% (p=.002), seclusion hours by 19% (p=.001), and proportion restrained by 30% (p=.03). The reduction in restraint hours was 55% but nonsignificant (p=.08). Individual facility effect sizes varied; some rates increased for some facilities. The dose-effect hypothesis was supported for two outcomes, seclusion hours and percentage restrained. The order of implementation group effects in relation to each outcome varied unpredictably. CONCLUSIONS: The 6CS was feasible to implement and effective in diverse facility types. Fidelity over time was nonlinear and varied among facilities. Further research on relationships between facility characteristics, fidelity patterns, and outcomes is needed.

Prevalence, risk factors and risk perception of tuberculosis infection among medical students and healthcare workers in Johannesburg, South Africa.

BACKGROUND: Tuberculin skin test (TST) and interferon gamma release assays (IGRAs) are both recommended for routine screening of healthcare workers (HCWs) in low tuberculosis (TB)-burden countries. More recently, based on scarce data, the World Health Organization strongly recommended that IGRA should not be used for occupational screening in high-burden settings. OBJECTIVE: To assess the prevalence of latent tuberculosis infection (LTBI) determined among highly exposed HCWs and low-exposed medical students in Johannesburg, South Africa. Methods. We performed a cross-sectional study using both TSTs and IGRAs to determine the prevalence rate of LTBI in 79 medical students and 120 HCWs providing HIV and/or TB care. RESULTS: The prevalence of LTBI among HCWs was 2- to 4-fold higher than that among medical students (56.7% v. 26.6% TST-positive; 69.2% v.15.2% IGRA-positive, respectively), with 3-fold higher odds for TST positivity and 12-fold higher odds for IGRA positivity among HCWs compared with students. Despite the perception of being at high risk, few HCWs protected themselves against LTBI. The majority of HCWs reported that they would participate in annual TST or IGRA screening. CONCLUSION: Infection control strategies and occupational screening programmes for professional and lay HCWs, as well as medical students, should be implemented in all high-burden settings. Further research is needed to determine whether IGRA or TST is the optimal assay for periodical screening of HCWs in high-burden settings.

Hospital life: better wise before the event.

Some of the problems of integrating a new casualty unit into a district general hospital are described by Dr. A. R. Dow, consultant, A & E unit, Sunderland District General Hospital. He discusses some of the advantages and lessons that can be learned for future development within the unit.

Effect of hyperoxia on the breathing of patients anaesthetized with infusions of propofol.

We have assessed the effects on the pattern of breathing of changing the inspired gas from air to oxygen, by analysing the 15 breaths before and 15 breaths after the change, in 10 patients anaesthetized with propofol. Eight of 14 changes decreased tidal volume (P < 0.01) by between 16% and 30%. Nine changes increased ventilatory cycle time (P < 0.01) by between 8% and 16%. Total ventilation decreased by between 7% and 33%. The peripheral chemoreceptors are active during propofol anaesthesia, and patients should be able to respond to hypoxia.

Effects of active and passive sighs in normoxia and hyperoxia on the breathing of patients anaesthetized with infusions of propofol.

Spontaneous augmented breaths (active sighs) reduced the tidal volume and inspiratory time of succeeding breaths; manual lung inflations (passive sighs) reduced the tidal volume but had little effect on inspiratory time. Sighs in air, whether active or passive, reduced tidal volume more than sighs in hyperoxia (100% oxygen or 33% oxygen in nitrous oxide) after both active and passive sighs (overall difference about 10%); the reduction in inspiratory time after a sigh was less affected by gas mixture. Calculated mean inspiratory flow was reduced after passive sighs, but active sighs were more likely to cause arousal, which complicated the analysis. Tidal volume was reduced after a sigh partly because of reduced peripheral chemoreceptor input, the main effect of which was to reduce inspiratory flow, and partly because inspiratory time was shorter. Although the chemoreceptors may affect inspiratory time after a sigh, the greater effect of active sighs compared with passive sighs makes it likely that the shortening was either part of the neural output that causes spontaneous sighs, or was caused by mechanoreceptor input not mimicked by manual lung inflation.

A citywide survey of vancomycin-resistant Enterococcus--New York City, 1993.

Vancomycin-resistant Enterococcus (VRE) has become an increasingly important nosocomial pathogen. Questionnaires were sent to all New York City (NYC)-licensed laboratories to ask about testing procedures used, number of isolates identified, species identified, and vancomycin susceptibility for enterococcal isolates in 1993. Of 127 laboratories, 118 (93%) responded. Fifty-three (45%) of the 118 laboratories reported both the number of enterococcal isolates tested and the number of VRE isolates identified during 1993; 15 (28%) of the 53 laboratories did not isolate VRE, and the remaining 38 laboratories identified 3,822 (8.1%) VRE isolates. VRE was first identified by a NYC-licensed (commercial) laboratory in 1988. Among NYC hospital laboratories, 65 (97%) of 67 identified at least one VRE isolate during 1989-1993. This survey demonstrates that there has been a marked increase in the number of VRE isolates identified in NYC laboratories.

Short- and long-term prognosis of patients with a subarachnoid haemorrhage in relation to intra-operative period of hypotension.

112 patients operated on for an intracranial aneurysm were surveyed. The immediate (up to 3 days from surgery) and late (from 3 days onwards and up to 2 years) outcome was examined in relation to the level and duration of per-operative hypotension as well as technical difficulties. The risk of both immediate and late post-operative neurological deficit was increased when the systolic blood pressure was pharmacologically reduced below the level of 60 mm Hg. The duration of such hypotension had a similar influence. A proportion of patients, following subarachnoid haemorrhage, respond poorly to hypotension and identification of these "vulnerable perfusers" by bedside cerebral blood flow or other monitoring procedures may be useful.

Patient-controlled epidural analgesia following post-traumatic pelvic reconstruction. A comparison with continuous epidural analgesia.

A randomised, single-blinded study was conducted to compare patient-controlled epidural analgesia with continuous infusion epidural analgesia for the treatment of pain following post-traumatic pelvic reconstruction. The patient-controlled group (n = 11) received a background infusion of 4 ml.h-1 of bupivacaine 0.125% with fentanyl 1 microgram.ml-1, and 3-6 ml bolus doses, self administered, as required (with a 15 min lockout interval). The continuous infusion group (n = 12) received a continuous infusion of the same solution through an identical apparatus, but with the demand button deactivated. This was started at 10 ml.h-1 and adjusted by the anaesthetist, as required, up to a maximum of 25 ml.h-1. Pain scores, side effects, and the volumes of drug infused were recorded over the first 3 postoperative days. One patient from each group was withdrawn because of catheter-related problems. Pain scores were similar and the incidence of nausea and pruritus was low in both groups. There was no recorded instance of respiratory depression or hypotension and there was no significant difference between the groups in the volumes of drug solution received. Patient satisfaction was equally very good in both groups. Patient-controlled epidural analgesia is an effective means of providing pain relief after post-traumatic pelvic reconstruction, but did not significantly reduce analgesic requirements in comparison with continuous infusion epidural analgesia.

Prevalence of tuberculosis infection among homeless young people in central and eastern Sydney.

OBJECTIVE: To determine the prevalence of tuberculosis (TB) infection among homeless young people (aged 12-25 years) in central and eastern Sydney. METHODOLOGY: A cross-sectional survey was conducted in 16 youth refuges and four drop-in centres in Central and Eastern Sydney Health Areas and at the Cellblock Youth Health Centre, Glebe and the Kirketon Road Centre, Darlinghurst, New South Wales (NSW). Participants completed a questionnaire and underwent Mantoux testing. RESULTS: One hundred and forty-one young people completed questionnaires and 139 received a Mantoux test; 112 (80. 6%) had their Mantoux read and 10 (8.9%) were Mantoux positive (95% confidence interval 3.6-14.2). None of the risk factors examined were found to be associated with increased risk for TB infection. CONCLUSIONS: In this sample of homeless young people in central and eastern Sydney, the Mantoux positivity rate appears to be higher than the general population in NSW, but they would not currently be considered a high-risk group for TB infection.