Challenges of investigating a large food-borne norovirus outbreak across all branches of a restaurant group in the United Kingdom, October 2016.

During October and November 2016, over 1,000 customers and staff reported gastroenteritis after eating at all 23 branches of a restaurant group in the United Kingdom. The outbreak coincided with a new menu launch and norovirus was identified as the causative agent. We conducted four retrospective cohort studies; one among all restaurant staff and three in customers at four branches. We investigated the dishes consumed, reviewed recipes, interviewed chefs and inspected restaurants to identify common ingredients and preparation methods for implicated dishes. Investigations were complicated by three public health agencies concurrently conducting multiple analytical studies, the complex menu with many shared constituent ingredients and the high media attention. The likely source was a contaminated batch of a nationally distributed ingredient, but analytical studies were unable to implicate a single ingredient. The most likely vehicle was a new chipotle chilli product imported from outside the European Union, that was used uncooked in the implicated dishes. This outbreak exemplifies the possibility of rapid spread of infectious agents within a restaurant supply chain, following introduction of a contaminated ingredient. It underlines the importance of appropriate risk assessments and control measures being in place, particularly for new ingredients and ready-to-eat foods.

The future shortage of doctoral prepared nurses and the impact on the nursing shortage.

Nursing remains at the top of the job growth market and has the potential to positively or negatively impact changes in the delivery of health care today. Professional nurses play a crucial role in the prevention of medication errors, decreasing infection rates, and facilitating a patient's safe transition from acute care into the home environment. Nurses must make critical life-saving decisions associated with caring for the more acutely ill patient. Doctoral prepared nurses have the unique position to assist the direct care nurse because of their advanced education. The doctor in nursing practice concentrates on direct care, specifically research utilization for improved delivery of care, patient outcomes, and clinical systems management There is a future shortage of doctoral prepared nurses, and a resolution is needed. Doctoral prepared nurses with advanced degrees play an important role in mentoring the bedside nurse to promote an interdisciplinary collaborative relationship. The doctor in nursing practice has the ability to effect change in health care systems, organizations, and policy through focusing on the essence of nursing-the care.