Preliminary Findings from an Investigation of Zika Virus Infection in a Patient with No Known Risk Factors - Utah, 2016.

On July 12, 2016, the Utah Department of Health (UDOH) was notified by a clinician caring for an adult (patient A) who was evaluated for fever, rash, and conjunctivitis that began on July 1. Patient A had not traveled to an area with ongoing Zika virus transmission; had not had sexual contact with a person who recently traveled; and had not received a blood transfusion, organ transplant, or mosquito bites (1). Patient A provided care over several days to an elderly male family contact (the index patient) who contracted Zika virus abroad. The index patient developed septic shock with multiple organ failure and died in the hospital on June 25, 2016. The index patient's blood specimen obtained 2 days before his death had a level of viremia approximately 100,000 times higher than the average level reported in persons infected with Zika virus (2). Zika virus infection was diagnosed in patient A by real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing on a urine specimen collected 7 days after symptom onset. In addition, a serum specimen collected 11 days after symptom onset, after patient A's symptoms had resolved, was positive for antibodies to Zika virus by Zika immunoglobulin M (IgM) capture enzyme-linked immunosorbent assay (MAC-ELISA) and had neutralizing antibodies detected by plaque-reduction neutralization testing (PRNT). Working with Salt Lake and Davis County Health Departments, UDOH requested assistance from CDC with an investigation to determine patient A's exposures and determine a probable source of infection.

PACS bypass: a semi-automated routing solution to enable filmless operations when PACS fails.

In the filmless imaging department, an integrated imaging and reporting system is only as strong as its weakest link. An outage or downtime of a key segment, such as the Picture Archive Communications System (PACS), is a significant threat to efficient workflow, quality of image interpretation, ordering clinician's review, and ultimately patient care. A multidisciplinary team (including physicists, technologists, radiologists, operations, and IT) developed a backup system to provide business continuity (i.e., quality control, interpretation, reporting, and clinician access) during an extended outage of the main departmental PACS.

A computerized analysis of robotic versus laparoscopic task performance.

INTRODUCTION: Robotic technology has been postulated to improve performance in advanced surgical skills. We utilized a novel computerized assessment system to objectively describe the technical enhancement in task performance comparing robotic and laparoscopic instrumentation. METHODS AND PROCEDURES: Advanced laparoscopic surgeons (2-10 yrs experience) performed three unique task modules using laparoscopic and Telerobotic surgical instrumentation (Intuitive Surgical, Sunnyvale, CA). Performance was evaluated using a computerized assessment system (ProMIS, Dublin, Ireland) and results were recorded as time (s), path (mm) and precision. Each surgeon had an initial training session followed by two testing sessions for each module. A paired Student's t-test was used to analyze the data. RESULTS: Ten surgeons completed the study. 8/10 surgeons had significant technical enhancement utilizing robotic technology. CONCLUSIONS: The ProMIS computerized assessment system can be modified to objectively obtain task performance data with robotic instrumentation. All the tasks were performed faster and with more precision using the robotic technology than standard laparoscopy.

How to Conduct the Patient Interview. Communicating successfully with patients requires strategy, flexibility and practice.

As community paramedicine and other nonemergent initiatives become commonplace in EMS, caregivers are going to need communication skills that go beyond SAMPLE checklists. A minimalist approach to dialogue with patients, considered preferred if not essential in what was once almost exclusively a light-and-sirens environment, isn't acceptable when prehospital interventions require a thorough understanding not only of chief complaints, but also how the physical part of illness and injury is framed by the patient's environment. Be considerate, be as thorough as time permits, and pay attention! Next time we'll talk about interviewing prospective employees.

Conducting the Student Interview. It's your best early chance to spot candidates not suited for EMS.

Student interviews help ensure a match between classroom imperatives and candidates'capabilities. Exploring students'maturity and judgment is often more important than confirming their academic proficiency. Walking into an interview unprepared can be as damaging for interviewers as for interviewees. Selecting the right people and the right process for conducting interviews depends on planning and practice. A team approach to interviewing can be particularly effective if team members take the time to discuss topics and roles before meeting with candidates. Although imprecise, interviews increase the chances that instructors and students will achieve mutually satisfying results, particularly when students play active roles. Next time we'll cover patient interviews.