Conceptual challenges in tailoring physician performance assessment to individual practice.

Practice inevitably narrows over time. Therefore, testing of established doctors requires that their assessment be tailored to a far narrower practice than is appropriate for testing of new doctors who have not yet differentiated. In this paper, we address the conceptual challenges of tailoring physician assessment to individual practice. Testing of established doctors needs to reflect that physicians specialise, often in idiosyncratic ways; otherwise, the testing will not be credible among established doctors and will not reflect the realities of their practice. Despite the importance of these goals, the conceptual and methodological challenges of creating tailored assessments remain daunting.

The use of dirty bedding for detection of murine pathogens in sentinel mice.

Sentinel Swiss (CD-1) mice, housed without filter bonnets, were seronegative for mouse hepatitis virus (MHV) for 8 consecutive months in an experimental colony of CD-1 mice. MHV titers had been detected sporadically in sentinel mice housed in this colony during a 2 year period. In an effort to determine whether MHV was still present in the colony, two methods of exposing sentinel mice to an animal room environment were compared under routine husbandry practices. Eight cages (12 mice per cage; 2 cages per rack) of experimental virus antibody free sentinel mice, housed without filter bonnets, were placed on the bottom shelf of 4 of 12 racks in the room. Twice each week, four cages of sentinel mice received a composite sample of dirty bedding (bedding used previously by mice in the room). The remaining four cages of experimental sentinels received fresh non-used bedding. Sentinel mice were bled at monthly intervals for MHV serology. After 4 months, mice from two cages which received dirty bedding seroconverted to MHV and mice from one cage were positive for Myobia musculi (mites). Three weeks later, all four cages of mice which received dirty bedding were positive for MHV and three were positive for mites. In contrast, only two of four cages of mice which received fresh bedding were positive for MHV and all were negative for mites. These findings indicate the importance of exposing sentinel mice to dirty bedding and that MHV and mites may go undetected for several months in a mouse colony when the incidence levels are low where standard sanitation procedures are used.