[Routine written intervention asserting the advantages of multiple blood cultures increases their order rate among doctors].

PURPOSE: Obtaining two or more blood culture sets is important for achieving good sensitivity and for detecting contamination. However, many doctors still only order one set for their laboratory testing. We wished to determine if routine written intervention to these doctors could increase the number of multiple blood cultures they ordered. MATERIALS AND METHODS: On November 11, 2011 at Tokyo Teishin Hospital, we began sending letters asserting the advantages of using multiple blood culture sets to doctors who only ordered solitary blood cultures. The effect of the intervention was determined by measuring the order rate of multiple blood culture sets at the hospital. We compared the order rate one year before intervention with that of one year after. We used a chi-square test (without Yates correction) to analyze the data, and p values less than 0.05 were considered to be statistically significant; all tests were two-tailed. RESULTS: Before written intervention, the order rate of multiple blood cultures was 41%. This increased significantly to 68% after intervention (p < 0.001). The latter figure was 1.7 times greater than the former (relative risk, 1.7; 95% confidence interval, 1.5-1.8). CONCLUSION: Routine written educational intervention asserting the advantage of multiple blood cultures led to an increase in their order rate by doctors. While this is a significant increase, it is still insufficient. Therefore, we propose the need for internal policies requiring at least two blood culture sets to ensure better sensitivity and detection of contamination. To enforce these policies, hospital personnel should be allowed to routinely intervene by either sending warning letters to the doctors or displaying this information on the patient's electronic chart.

Microscopic polyangiitis accompanied by pleuritis as the only pulmonary manifestation of occupational silica exposure.

A 68-year-old man, who had worked for processing quartz-containing stones for more than 50 years, complained of low-grade fever and arthralgia. Mediastinal lymph nodes were markedly swollen on chest computed tomography. Pathological findings of the lymph node were compatible with silicosis, with a high titer of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA). During follow-up with prednisolone treatment, pleuritis and uveitis developed as manifestations of vasculitis. Thus, he was diagnosed with MPO-ANCA-associated vasculitis with occupational silica exposure, possibly microscopic polyangiitis (MPA). This case is rare, because pleuritis was the only pulmonary manifestation, without interstitial pneumonia, alveolar hemorrhage or glomerulonephritis.

An adult case of multiple squamous papillomas of the trachea associated with human papilloma virus type 6.

A 72-year-old woman with primary biliary cirrhosis complained of dry cough and wheezing. Chest computed tomography showed a tumor arising from the posterior wall of the trachea. Bronchoscopic examination revealed that the tumor was cauliflower-like, with two small polypoid tumors. They were diagnosed as multiple squamous papillomas. The main tumor was recurrent and removed by repeated microwave coagulation therapy (MCT) through bronchoscopy, whereas the two polypoid tumors were likely to disappear spontaneously. Human papilloma virus (HPV) type 6 DNA was detected in the tumor by polymerase chain reaction (PCR) amplification, suggesting that this virus was the cause of her papillomas.