Academic affiliation with a nursing home. Impact on patient outcome.

In a prospective study, 46 patients discharged from a teaching hospital to a "teaching unit" nursing home, where primary medical care was provided by faculty geriatricians, medical students, and medical housestaff, were compared with 78 similar patients discharged to one of five community nursing homes without a teaching affiliation. At the time of hospital discharge, patients were determined to have a terminal, rehabilitative, or long stay prognosis based on a review of hospital discharge summaries using specific criteria. Among 34 study and 55 control patients with a long stay prognosis, ten of the study group compared with seven of the control group returned home (P = .03). Seven of 34 long stay patients in the study group were rehospitalized, while 15 of a matched control group of 34 required hospitalization (P = .04). There was no increase in mortality or emergency service use in the study population. Patients considered to be terminal or rehabilitative showed no difference in ultimate outcome or hospital use. In the study group patients experienced an average reduction in total medications prescribed from 6.2 to 5.3, while patients in the control group had an increase from 5.4 medications prescribed to 7.6 (P less than .001). Of 16 study patients discharged from the teaching unit nursing home, all remained home at least three months after discharge; only 12 of 18 control group patients discharged from the nursing home remained at home at three months (P less than .01). Long-term care by geriatric faculty, students, and housestaff appeared to have favorably influenced patient outcomes.

Estimation of most probable number of Salmonella in retail samples of minced pork.

The number of salmonellae in 174 samples of minced pork was determined by the Most Probable Number (MPN) method in two separate laboratories. The material examined was taken from a collection of samples which were Salmonella positive in an earlier study. The MPN estimation was carried out using portions of original samples which had been divided (2 x 100 g) before the initial examination and which had been deep frozen and stored for 1 to 14 weeks at -18 degrees C until re-examination. Of the 174 samples initially positive for Salmonella, 131 (75.3%) were positive on re-examination using pre-enrichment in buffered peptone water (BPW) and selective enrichment in Rappaport-Vassiliadis medium (RV) and in tetrathionate medium according to Muller-Kauffmann (MK). The majority of the samples gave Salmonella counts below 1000/100 g (96.7% at lab. A and 97.3% at lab. B). Comparison of the results from both laboratories showed good agreement in the distribution pattern of the frequencies within the MPN classes, but agreement between the same sample pair was poor (r = 0.23). RV medium proved to be superior to the MK medium.

Microflora of Edible Offal with Particular Reference to Salmonella.

Feeding of raw offal has been suspected to be a major source of Salmonella infections among pets, particularly among dogs, in the city of Berlin (West). The present study revealed that 231 (56.6%) of 408 samples of edible offal (liver, lungs, heart, bovine rumen, porcine esophagus) contained 24 types of Salmonella . Salmonella typhimurium prevailed (145 samples = 62.8% of the positive samples = 35.5% of the total), including 8 strains of S. typhimurium var. copenhagen . Three types had an incomplete seroformula. The investigation covered a period of 26 months. The percentage of positive findings did not significantly differ during various seasons. Positive findings were most frequent with porcine esophagus (40/49) and least frequent with imported swine liver (17/58) and bovine rumen (13/45). Presence of salmonellae was not correlated with other microbiological criteria, in particular aerobic plate count and number of Enterobacteriaceae . All samples were sold at West-Berlin's central wholesale meat market and originated from slaughter animals judged as "fit for consumption", which means that they were also intended for human consumption and not only as animal feed. Repeated isolation of the same Salmonella type from different samples taken on the same day indicated rapid spreading during transport and storage. This contamination did not persist for a longer period but was replaced by other strains which subsequently appeared. Since raw offal for retail sale represents a considerable health hazard, it is recommended that this material should not be offered for retail sale unless in hermetically sealed packages. Packages should have labels with directions for proper handling of the contents in the home. Warning should also be given that viscera should neither be eaten raw nor fed to pets unless the material is adequately heated.