The emergence of oseltamivir-resistant pandemic influenza A (H1N1) 2009 virus amongst hospitalised immunocompromised patients in Scotland, November-December, 2009

To investigate the frequency of oseltamivir resistance in circulating strains of the 2009 influenza A(H1N1) pandemic virus in Scotland, 1,802 samples from 1,608 infected hospitalised patients were screened by the H275Y discriminatory RT-PCR. Among these, we identified 10 patients who developed the H275Y mutation. All of them were immunocompromised and were under treatment or had been treated previously with oseltamivir.

Quality of stroke care at an Irish Regional General Hospital and Stroke Rehabilitation Unit

BACKGROUND

Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided.

AIM

The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU).

METHODS

A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool.

RESULTS

The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively.

CONCLUSION

The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.

Training outcomes in colorectal cancer surgery in a district general hospital

OBJECTIVES

The purpose of this study was to quantify the effect of training on outcomes following colorectal cancer resections in a District General Hospital.

PATIENTS AND METHODS

Data on 102 consecutive elective colorectal cancer resections performed at a District General Hospital over a three-year period were prospectively collated. The proportion of cases performed by trainees was recorded and the seniority of the operating surgeon was related to pre-operative morbidity, operative time and postoperative outcome.

RESULTS

Consultants, staff grades and registrars performed 46, 35 and 21 procedures respectively. Of the cases performed by registrars, consultant supervision was provided in seven cases, with staff grades providing supervision in 14 cases. As compared with consultants, registrars were less likely to undertake anterior resection (p = 0.001). However, the mean operating times of trainees (145 +/- 8 mins) and consultants (135 +/- 6 mins) were similar. There were no significant differences between the groups with respect to postoperative mortality or morbidity. There was a trend towards more advanced disease in consultant cases, and consultants had a significantly poorer freedom from death or recurrence at two years as compared with trainees (p = 0.03).

CONCLUSIONS

In our unit, trainees performed 21% of all elective colorectal resections with no detrimental effect on length of hospital stay, overall hospital costs and early and late patient outcomes. Major colorectal procedures can be successfully accomplished in a District General setting by trainees, with the training burden shared between consultants and staff grade surgeons.

Arsenate sorption by hydrous ferric oxide incorporated onto granular activated carbon with phenol formaldehyde resins coating

A simple and effective method was developed using phenol formaldehyde (PF) resins to immobilize hydrous ferric oxide (HFO) onto granular activated carbon (GAC). The resulting sorbent possesses advantages for both the ferric oxide and the GAC, such as a great As-affinity of ferric oxide, large surface area of GAC, and enhanced physical strength. The studies showed that within one hour this sorbent was able to remove 85% of As(V) from water containing an initial As(V) concentration of 1.74 mg l(-1). The As(V) adsorption onto the sorbent was found to follow a pseudo-second order kinetics model. The adsorption isotherms were interpreted in terms of the Langmuir and Freundlich models. The equilibrium data fitted very well to both models. Column tests showed that this sorbent was able to achieve residual concentrations of As(V) in a range of 0.1-2.0 microg l(-1) while continuously treating about 180 bed volume (BV, 130 ml-BV) of arsenate water with an initial As(V) concentration of 1886 microg l(-1) at a filtration rate of 13.5 ml min(-1), i.e., an empty bed contact time (EBCT) of 9.6 min and a gram sorbent contact time (GSCT) of 0.15 min. After passing 635 BV of arsenate water, the exhausted sorbent was then tested by the Toxicity Characteristic Leaching Procedure (TCLP, US EPA Method 1311) test, and classified as non-hazardous for disposal. Hence, this HFO-PF-coated GAC has the capability to remove As(V) from industrial wastewater containing As(V) levels of about 2 mg l(-1).

Stroke unit care: recurrence, mortality and institutionalisation rates-a four year follow-up study

BACKGROUND

he benefits of stroke unit care in terms of reducing mortality, morbidity and the need for institutional care in the short term are clear. Less evidence exists of its longer term benefits.

AIM

The aim of this study was to measure the rates of mortality, institutionalisation and stroke recurrence over a4-year period following stroke unit care.

METHODS

Discharge and 4-year follow-up data were examined on all patients admitted to the Stroke Rehabilitation Unit between September 2000 and August 2002. There results were compared with previously published data.

RESULTS

After 4 years 8% of patients had sustained are current stroke, 40% were deceased and 40% were in institutional care.

CONCLUSIONS

Compared to international data care at our unit appears to be associated with a lower rate of recurrent stroke and mortality but a higher institutionalisation rate after 4 years. The reasons for this are unclear.

Maternal folate status and neural tube defects in Ireland: the need for a national food fortification program

To determine the present risk of a Neural Tube Defect [NTD] pregnancy in the caucasian primigravid population in Dublin by comparing the serum folate and red cell folate status of primigravid patients attending the first prenatal booking clinic with data from the late 80's. This Cross-sectional population study looking at blood folate status of over 400 sequential primigravid caucasian women with a singleton pregnancy, booking at less than or equal to 20 weeks gestation. All patients were attending a prenatal booking clinic at the Rotunda Hospital in Dublin during 2003-2004. Comparing serum and red cell folate values in 454 primigravid patients in 2003-4 to values to in a large case-control study based on over 56,000 women attending maternity hospitals in Dublin from 1986 to 1990. Just 13.9% of our patients took periconceptual folate, 33.5% of patients took folate in the first 20 weeks of pregnancy and 58.8% of mothers were taking no folate supplement. Overall, 30% of mothers had RCF levels below 400 ug/L--a level recommended as the minimum value required for protection. NTD risk occurred most frequently amongst patients with RCF levels between 300 and 400 ng/mL.

Stroke unit care is superior to general rehabilitation unit care

Robust evidence exists for the efficacy of stroke units in improving stroke outcome. To date no Irish and little international data exist comparing stroke unit and general rehabilitation unit care. 207 patients admitted to a stroke unit (136--65.7%) and a general rehabilitation unit (71--34%) in the Mid-Western region from September 2000-August 2002 were included in the study. There was no difference in patient age, gender or admission criteria between the units. The stroke unit was associated with a shorter length of stay (mean 21 versus 33 days, p < 0.01) and a higher rate of home discharge (50% versus 38%, p < 0.01). Patient survival at discharge (86% versus 70.4%, p < 0.01), 3 months (84.5% versus. 69.5%, p < 0.01) and 6 months (81% versus. 66%, p < 0.01) post-admission was better among stroke unit patients.

Smoking and alcohol in pregnancy. Survey in the immediate post-partum period

This was a questionnaire-based study of 151 postnatal women. We found 42% of women were smokers prior to pregnancy and only 37% of these women succeeded in quitting smoking during pregnancy. Success in quitting was significantly related to the number of cigarettes smoked (p<0.05). However, 71% of pregnant smokers were aware of the associated risks. Alcohol was consumed by 89% of women and 10% admitted to binge drinking during pregnancy. Only 44% of the study group were aware of the associated risks of alcohol. We propose that we need to change our social acceptance of these behaviours before pregnancy, and provide support to those women during pregnancy.

Is vaginal breech delivery outdated for all singletons and twins? The current kaleidoscope of obstetric thinking

The best practice for the delivery of a term breech in singleton and twin pregnancies is still controversial. We sought the opinions of obstetricians working in Ireland. A questionnaire was used to address the management of the obstetrician's "own hypothetical pregnancy" in three different scenarios. We also inquired about factors which might influence the decision on mode of delivery. The response rate was 104/174 (60%). In the scenario of a singleton fetus presenting by the breech in a nulliparous woman, 15/84 (18%) of obstetricians would chose a spontaneous vaginal delivery compared to 40/80 (50%) for a multiparous woman (p < 0.01). In the scenario of a second twin in breech presentation (nulliparous and multiparous), 75/93 (81%) would choose a spontaneous vaginal delivery. When asked about a singleton cephalic presentation, 85/91 (93%) would choose a spontaneous vaginal delivery. These decisions were influenced by concerns about perinatal morbidity [91/100 (91%)], published evidence [73/98 (75%)], the delivery doctor's inexperience [56/94 (60%)], but not by gender. Our study indicates that obstetricians in Ireland consider that there is a role for vaginal breech delivery in selected scenarios.

Quality control and reference guidelines for CLSI broth microdilution susceptibility method (M 38-A document) for amphotericin B, itraconazole, posaconazole, and voriconazole

Although standard conditions are available for testing the susceptibilities of filamentous fungi to antifungal agents by the Clinical and Laboratory Standards Institute (CLSI; formerly National Committee for Clinical Laboratory Standards) broth microdilution assay, quality control (QC) MIC limits have not been established for any mold-agent combination. This multicenter (eight-center) study documented the reproducibility of tests for one isolate of Paecilomyces variotii ATCC MYA-3630 and 11 other mold isolates (three isolates of Aspergillus fumigatus; two isolates of A. terreus; one isolate each of A. flavus, A. nidulans, Fusarium moniliforme, and F. solani; and two isolates of Scedosporium apiospermum) by the CLSI reference broth microdilution method (M 38-A document). Control limits (amphotericin B, 1 to 4 microg/ml; itraconazole, 0.06 to 0.5 microg/ml; posaconazole, 0.03 to 0.25 microg/ml; voriconazole, 0.015 to 0.12 microg/ml) for the selected QC P. variotii ATCC MYA-3630 were established by the analysis of replicate MIC results. Reference isolates and corresponding MIC ranges were also established for 6 of the 12 molds evaluated. MIC limits were not proposed for the other five molds tested due to low testing reproducibility for these isolates.

Granisetron vs ondansetron for prevention of nausea and vomiting in hematopoietic stem cell transplant patients: results of a prospective, double-blind, randomized trial

The serotonin type-3 (5-HT3) antagonists represent a significant advance in the prevention of acute nausea and vomiting (N/V) from highly emetogenic chemotherapy. We sought to determine if any differences in efficacy or adverse effects exist between two such agents, ondansetron and granisetron, during conditioning therapy for hematopoietic stem cell transplantation (HSCT). Patients were randomized to receive either ondansetron 0.15 mg/kg intravenously every 8 h or granisetron 10 microg/kg intravenously daily. Additionally, all patients received scheduled dexamethasone and lorazepam. Prophylaxis was continued until 24 h after completion of chemotherapy. Nausea and distress were measured subjectively with visual analog scales and emetic episodes were quantified. Of the 110 randomized patients, 96 were evaluable for efficacy and safety. No significant differences in efficacy were observed between the ondansetron- and granisetron-treated patients, evaluated by comparing the degree of nausea and distress, number of emetic episodes and overall control of emesis. The adverse effects were also comparable and no patients were removed from study because of severe toxicities. This trial demonstrates that ondansetron and granisetron are equally effective at preventing acute N/V associated with conditioning therapy frequently used for HSCT. The agent of choice should be based on drug acquisition cost or preference.