Adult Asthma Diagnosis: Physician Reported Challenges in Alberta-Based Primary Care Practices.

INTRODUCTION: An estimated 8.1% of Canadians adults have asthma. While there are challenges associated with the use of objective measurement of lung function in the diagnosis of asthma, we are uncertain of the barriers that impact the use of objective measures, and have limited understanding of the challenges experienced by primary care providers in diagnosis of asthma. The objectives of this quality improvement initiative were to identify primary care providers' methods of diagnosing asthma and to identify challenges with diagnosis. METHODS: An online survey was disseminated using a snowball methodology. SETTING: Primary care practices in Alberta, Canada. PARTICIPANTS: A total of 84 primary care providers completed the survey. MAIN OUTCOME MEASURES: Participants were asked their ideal and sufficient methods for diagnosing asthma and to identify challenges in their practice related to asthma diagnosis. RESULTS: They identified full pulmonary function testing (54%), pre- and postbronchodilator spirometry (54%), complete history and physical (42%), peak flow measurement overtime (26%), pulmonary consult (26%), and trial of asthma medication(s) (23%), as ideal methods of diagnosing asthma. The most significant barriers to diagnosis included episodic care-care provided typically during times of worsening symptoms without ongoing preventative/maintenance care (55%), patient follow-up (44%), conflict between clinical impression and pulmonary function results (43%), patient already on asthma medications (43%), and interpreting spirometry/pulmonary function results (39%). CONCLUSION: The results of this survey indicate that the majority of primary care providers would choose full pulmonary function testing or pre- and postbronchodilator spirometry as the ideal methods of diagnosing asthma. However, barriers related to the nature of asthma care, patient factors, and challenges with diagnostic testing create challenges. This study also highlights that primary care providers have adapted to challenges in leveraging objective measurement and may rely upon other methods for diagnosis such as trials of medications.

[Leuconostocs in raw milk: isolation and identification of species rapidly utilizing lactose]. / Leuconostocs en leche cruda: aislamiento e identificación de especies de utilización rápida de lactosa.

Fast lactose fermenting Leuconostoc species and subspecies were isolated from raw milk. Samples were obtained from dairy farms of the surroundings of Buenos Aires city. A lactose, non selective, isolation medium was employed (YCL). Differentiation of leuconostocs from Lactobacillus viridescens and L. confusus was avoided on account of the use of this medium. 801 typical colonies of lactic acid bacteria were selected from YCL agar; 710 of them were identified as lactic acid bacteria from which 114 strains belonged to the genus Leuconostoc. These last strains were then tested for species and subspecies differentiation by dextran production and sugar fermentation. Leuconostoc mesenteroides subsp. dextranicum and L. lactis were identified. Four strains identified as Leuconostoc spp do not belong to any known species.

Leuconostocs en leche cruda: aislamiento e identificación de especies de utilización rápida de lactosa. / [Leuconostocs in raw milk: isolation and identification of species rapidly utilizing lactose]

Fast lactose fermenting Leuconostoc species and subspecies were isolated from raw milk. Samples were obtained from dairy farms of the surroundings of Buenos Aires city. A lactose, non selective, isolation medium was employed (YCL). Differentiation of leuconostocs from Lactobacillus viridescens and L. confusus was avoided on account of the use of this medium. 801 typical colonies of lactic acid bacteria were selected from YCL agar; 710 of them were identified as lactic acid bacteria from which 114 strains belonged to the genus Leuconostoc. These last strains were then tested for species and subspecies differentiation by dextran production and sugar fermentation. Leuconostoc mesenteroides subsp. dextranicum and L. lactis were identified. Four strains identified as Leuconostoc spp do not belong to any known species.

[Modification of the Pack method for the microdetermination of diacetyl in mixed cultures]. / Modificación del método de Pack para la microdeterminación de diacetilo en cultivos mixtos.

Prill and Hammer's method (4) for microdetermination of diacetyl was modified by several authors (1-3, 7), but retaining the same principle: diacetyl is converted into dimethylglyoxime by reaction with hydroxylamine; the oxime is subsequently converted into a pink ammonoferrous glyoximate and its colour is measured by absorbance at 530 nm. In the present communication a procedure based on the method of Pack et al. (3) is proposed with the following modifications: 1. Omission of carboy and suction flask; 2. Elongation of the connecting tubing between sample and trap tubes and relocation of the trap tubes to a higher level. 3. Replacement of rubber tubing by pvc connection and of rubber stoppers by neoprene ones. 4. A more accurate regulation of the nitrogen flow. 5. Protection of the Fe SO4 against oxidation. 6. Omission of the rinse of the trap tips with K2 HPO4 solution. 7. Use of diacetyl as a standard instead of dimethylglyoxime.

Modificación del método de Pack para la microdeterminación de diacetilo en cultivos mixtos / [Modification of the Pack method for the microdetermination of diacetyl in mixed cultures]

Prill and Hammer’s method (4) for microdetermination of diacetyl was modified by several authors (1-3, 7), but retaining the same principle: diacetyl is converted into dimethylglyoxime by reaction with hydroxylamine; the oxime is subsequently converted into a pink ammonoferrous glyoximate and its colour is measured by absorbance at 530 nm. In the present communication a procedure based on the method of Pack et al. (3) is proposed with the following modifications: 1. Omission of carboy and suction flask; 2. Elongation of the connecting tubing between sample and trap tubes and relocation of the trap tubes to a higher level. 3. Replacement of rubber tubing by pvc connection and of rubber stoppers by neoprene ones. 4. A more accurate regulation of the nitrogen flow. 5. Protection of the Fe SO4 against oxidation. 6. Omission of the rinse of the trap tips with K2 HPO4 solution. 7. Use of diacetyl as a standard instead of dimethylglyoxime.

Modificación del método de Pack para la microdeterminación de diacetilo en cultivos mixtos. / [Modification of the Pack method for the microdetermination of diacetyl in mixed cultures]

Prill and Hammers method (4) for microdetermination of diacetyl was modified by several authors (1-3, 7), but retaining the same principle: diacetyl is converted into dimethylglyoxime by reaction with hydroxylamine; the oxime is subsequently converted into a pink ammonoferrous glyoximate and its colour is measured by absorbance at 530 nm. In the present communication a procedure based on the method of Pack et al. (3) is proposed with the following modifications: 1. Omission of carboy and suction flask; 2. Elongation of the connecting tubing between sample and trap tubes and relocation of the trap tubes to a higher level. 3. Replacement of rubber tubing by pvc connection and of rubber stoppers by neoprene ones. 4. A more accurate regulation of the nitrogen flow. 5. Protection of the Fe SO4 against oxidation. 6. Omission of the rinse of the trap tips with K2 HPO4 solution. 7. Use of diacetyl as a standard instead of dimethylglyoxime.

[Fishing seawater microbiology of the Mar de Plata]. / Estudio microbiológico de las aguas del Puerto Pesquero de Mar del Plata

This work deals with different groups of microorganisms in the polluted water of the fishery section of Mar del Plata harbour and in the way followed by the fisher's boats. Bacteriological determinations were: total count, MPN of coliforms, proteolitic and anaerobic bacteria. These groups were selected because of their activity in fish spoilage and/or infection. The microbial groups were studied as follows: direct plate count for total number, most probable number (MPN) for coliforms and fecal type strains according with Mc Crady tables; proteolitic and anaerobic bacteria were cualitatively tested, cuantitative determinations are given in two tables. Obtained results show a heavy water pollution that rapidly decreases towards the harbour entrance.

Estudio microbiológico de las aguas del Puerto Pesquero de Mar del Plata / [Fishing seawater microbiology of the Mar de Plata]

This work deals with different groups of microorganisms in the polluted water of the fishery section of Mar del Plata harbour and in the way followed by the fishers boats. Bacteriological determinations were: total count, MPN of coliforms, proteolitic and anaerobic bacteria. These groups were selected because of their activity in fish spoilage and/or infection. The microbial groups were studied as follows: direct plate count for total number, most probable number (MPN) for coliforms and fecal type strains according with Mc Crady tables; proteolitic and anaerobic bacteria were cualitatively tested, cuantitative determinations are given in two tables. Obtained results show a heavy water pollution that rapidly decreases towards the harbour entrance.

Estudio microbiológico de las aguas del Puerto Pesquero de Mar del Plata / [Fishing seawater microbiology of the Mar de Plata]

This work deals with different groups of microorganisms in the polluted water of the fishery section of Mar del Plata harbour and in the way followed by the fisher’s boats. Bacteriological determinations were: total count, MPN of coliforms, proteolitic and anaerobic bacteria. These groups were selected because of their activity in fish spoilage and/or infection. The microbial groups were studied as follows: direct plate count for total number, most probable number (MPN) for coliforms and fecal type strains according with Mc Crady tables; proteolitic and anaerobic bacteria were cualitatively tested, cuantitative determinations are given in two tables. Obtained results show a heavy water pollution that rapidly decreases towards the harbour entrance.