The Consensus from the Mycobacterium avium ssp. paratuberculosis (MAP) Conference 2017.

On March 24 and 25, 2017 researchers and clinicians from around the world met at Temple University in Philadelphia to discuss the current knowledge of Mycobacterium avium ssp. paratuberculosis (MAP) and its relationship to human disease. The conference was held because of shared concern that MAP is a zoonotic bacterium that poses a threat not only to animal health but also human health. In order to further study this problem, the conferees discussed ways to improve MAP diagnostic tests and discussed potential future anti-MAP clinical trials. The conference proceedings may be viewed on the www.Humanpara.org website. A summary of the salient work in this field is followed by recommendations from a majority of the conferees.

Improving operating room and perioperative safety: background and specific recommendations.

The 1999 Institute of Medicine report To Err Is Human put a spotlight on death from preventable medical errors. Surgically related errors are second only to medication errors as the most frequent cause of error-related death. Although many hospitals have ongoing programs to improve medication safety, most hospitals are not focused in a meaningful way on operating room (OR) safety despite the import of the OR to the hospital's finances and despite clearly efficacious available technologies. The perioperative environment is a high-risk area with high velocity, high complexity, and high stakes. OR errors lead to disproportionately more harm than errors elsewhere in the hospital. Actual adverse events are relatively rare in any given OR suite, but near misses are rather common. It is possible to learn much from evaluating near misses (along with adverse events) with root-cause analyses and then instituting changes in processes and systems to assist humans from making their inevitable errors. This article outlines approaches that when combined can markedly improve safety in the OR.

Video technology to advance safety in the operating room and perioperative environment.

Video is a powerful medium and is underused for patient safety in several areas: education, real-time consultation, process improvement, research, and workflow coordination. We illustrate this point through an overview of uses of video in health care by the authors and others in several institutions. These uses were in the context of team work training, operating room coordination, technical skills of invasive procedures, process improvement, telementoring, and multimedia video records. Also described are several key issues associated with the use of video, such as ethics and legal concerns. Technology advances and new methods will make video an important tool for improving patient safety.

Febrile neutropenia, colony-stimulating factors and therapy: time for a new methodology?

The utilization of granulocyte colony-stimulating factors (G-CSF) in febrile neutropenia has been controversial for many years. Berghmann et al.'s meta-analysis again demonstrates that G-CSF does not have an impact on mortality in febrile neutropenia, because the depth and duration of neutropenia in the trials are variable. Also, with mortality from febrile neutropenia less than 15%, any further study would require a vast number of patients to demonstrate a difference in mortality. The Elting and Cantor review provides a new paradigm to studies in patients with febrile neutropenia. These authors recognize that cost, quality of life, life-years gained and adverse events experienced with new therapies should be evaluated, in addition to the standard measures of infection resolution and related mortality. Therefore, for the evaluation of new therapeutic interventions, a consensus on stratified risk factors or the use of an already established model could provide end-points with comparable measurements.