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1.
Rev Sci Tech ; 38(3): 695-702, 2019 12.
Article in English | MEDLINE | ID: mdl-32286575

ABSTRACT

The economic costs of contagious agalactia (CA) to the small ruminant dairy industry are not well known but include losses due to mortality, lowered milk production, spoiled products, abortions and animal welfare problems, as well as diagnosis and treatment. This paper reports financial estimates made in southern Europe, including a study on small- and large-scale farming systems in Italy, indicating that the financial losses are high and underestimated. Furthermore, the current control strategies, including chemotherapy and vaccination, in selected countries in Europe are described. In some countries, disease control is hampered by excessively strict veterinary legislation which discourages farmers and private veterinarians from notifying outbreaks because it leads to the prohibition of milk sales and can result in delays in lifting restrictions. In addition, new European Union legislation may downgrade the importance of CA, which will have implications for international research efforts. Finally, a series of recommendations are provided that cover the proper notification and handling of CA outbreaks, including movement control, current diagnostics, treatment, vaccination and disinfection.


Si le coût économique exact de l'agalaxie contagieuse pour le secteur ovin et caprin de production laitière n'est pas connu, on sait néanmoins qu'il recouvre les pertes dues à la mortalité dans les cheptels, à une chute de la production de lait, aux produits altérés, aux avortements et aux problèmes de bien-être animal, en plus des coûts du diagnostic et des traitements. Les auteurs font état d'estimations financières réalisées en Europe méridionale, dont une étude sur les exploitations familiales et les élevages de grande taille en Italie, qui coïncident dans le constat de pertes financières à la fois importantes et sous-estimées. Les auteurs décrivent également les stratégies de lutte mises en place actuellement par plusieurs pays d'Europe, en particulier l'antibiothérapie et la vaccination. Dans certains pays, les efforts de lutte sont entravés par une législation vétérinaire excessivement rigoureuse qui dissuade les éleveurs et les vétérinaires privés de notifier les foyers car cela entraîne l'interdiction de vendre le lait issu des troupeaux infectés et retarde la levée des mesures de restriction. En outre, la nouvelle réglementation de l'Union européenne risque d'abaisser l'importance de l'agalaxie contagieuse, ce qui aura des conséquences sur les efforts mobilisés par la recherche au niveau international. Pour conclure, les auteurs formulent plusieurs recommandations en vue d'une notification et gestion appropriées des foyers d'agalaxie contagieuse, notamment pour ce qui concerne le contrôle des mouvements d'animaux, les méthodes actuelles de diagnostic, le traitement, la vaccination et la désinfection.


Aunque no se conocen bien los costos económicos que la agalaxia contagiosa inflige a la industria lechera de pequeños rumiantes, se sabe que las pérdidas por mortalidad, mengua de la producción lechera, productos echados a perder, abortos y problemas de bienestar animal son un factor importante, sin olvidar los gastos de diagnóstico y tratamiento. Los autores dan cuenta de cálculos económicos realizados en Europa meridional, en particular a raíz de un estudio de pequeñas y grandes explotaciones ganaderas de Italia, que llevaron a la conclusión de que las pérdidas económicas son cuantiosas y están subestimadas. Además, los autores describen los métodos de lucha aplicados actualmente en determinados países de Europa, que incluyen tratamiento medicamentoso y vacunaciones. En algunos países la lucha contra la enfermedad se ve lastrada por una legislación veterinaria demasiado estricta, que no alienta a productores y veterinarios privados a notificar brotes porque ello conduce a la prohibición de las ventas de leche y puede demorar el levantamiento de las restricciones. Por otra parte, hay nuevos textos legislativos de la Unión Europea que quizá vengan a restar importancia a la agalaxia contagiosa, lo que repercutiría en las actividades internacionales de investigación. Por último, los autores formulan una serie de recomendaciones referidas a cuestiones que van desde la correcta notificación y gestión de los brotes de agalaxia contagiosa hasta el control de los desplazamientos, pasando por los procedimientos vigentes de diagnóstico o los métodos de tratamiento, vacunación y desinfección.


Subject(s)
Dairying , Legislation, Veterinary , Mycoplasma Infections/economics , Mycoplasma Infections/prevention & control , Animal Welfare , Animals , Disease Outbreaks/veterinary , Europe
2.
Transbound Emerg Dis ; 65 Suppl 1: 91-109, 2018 May.
Article in English | MEDLINE | ID: mdl-29582590

ABSTRACT

There is a worldwide problem of disease caused by Mycoplasma (M.) bovis in cattle; it has a significant detrimental economic and animal welfare impact on cattle rearing. Infection can manifest as a plethora of clinical signs including mastitis, pneumonia, arthritis, keratoconjunctivitis, otitis media and genital disorders that may result in infertility and abortion. Current diagnosis and control information are reviewed and analysed to identify gaps in knowledge of the causative organism in respect of the disease pathology, diagnosis and control methods. The main considerations are as follows: no vaccines are commercially available; antimicrobial resistance is increasing; diagnostic and antimicrobial sensitivity testing needs to be improved; and a pen-side test would facilitate more rapid diagnosis and implementation of treatment with antimicrobials. More data on host susceptibility, stress factors, immune response and infectious dose levels are required. The impact of asymptomatic carriers, M. bovis survival in the environment and the role of wildlife in transmitting the disease also needs investigation. To facilitate development of vaccines, further analysis of more M. bovis genomes, its pathogenic mechanisms, including variable surface proteins, is required, along with reproducible disease models.


Subject(s)
Cattle Diseases/diagnosis , Cattle Diseases/prevention & control , Communicable Disease Control/methods , Mycoplasma Infections/veterinary , Mycoplasma bovis/isolation & purification , Animals , Anti-Bacterial Agents/therapeutic use , Bacterial Vaccines/administration & dosage , Cattle , Cattle Diseases/microbiology , Female , Mycoplasma Infections/diagnosis , Mycoplasma Infections/microbiology , Mycoplasma Infections/prevention & control , Mycoplasma bovis/pathogenicity
3.
Rev Sci Tech ; 37(3): 831-836, 2018 12.
Article in English | MEDLINE | ID: mdl-30964465

ABSTRACT

Contagious caprine pleuropneumonia (CCPP) was detected for the first time on the European continent in the Thrace region of Turkey in 2002 following outbreaks of an unusually severe respiratory disease in goats. Mycoplasma capricolums ubspecies capripneumoniae (Mccp), the causative agent, was identified in many infected herds throughout the region by serological, bacteriological and molecular biological techniques. However, as no quantitative data on the prevalence and distribution of the disease have been gathered in the intervening years, the extent of infection is unknown. Consequently, in 2014, a random sample of 2,400 goats was drawn from a population of over 167,000 goats in the region by multistage sampling. Serum samples were collected and tested by a monoclonal antibodybased competitive enzyme-linked immunosorbent assay (cELISA). The overall prevalence of CCPP in Thrace was found to be just over 8%. The prevalence in the individual provinces was approximately 18%, 7%, 8% and 6% for Çanakkale, Edirne, K?rklareli and Tekirda?, respectively, while Istanbul province appeared to be CCPP-free. The results showed that CCPP has spread throughout the region and has become endemic, and may pose a potential risk to the neighbouring countries of Greece and Bulgaria. Mccp was regularly detected from lung samples of suspect goats until 2015 but since then there has been no further detection from clinical samples.


La pleuropneumonie contagieuse caprine (PPCC) était détectée pour la première fois sur le continent européen en Thrace orientale (Turquie) en 2002, à la suite de foyers d'une maladie respiratoire particulièrement sévère affectant le cheptel caprin. L'agent causal identifié par diverses méthodes sérologiques, bactériologiques et de biologie moléculaire dans plusieurs troupeaux infectés de la région était Mycoplasma capricolum sous-espèce capripneumoniae (Mccp). Cependant, en l'absence de données quantitatives sur la prévalence et la distribution de la maladie depuis ces foyers, l'extension de l'infection est restée inconnue. Pour y remédier, un échantillonnage stratifié et aléatoire de2 400 chèvres parmi une population de plus de 167 000 chèvres de la région a été réalisé en 2014. L'analyse par la méthode immunoenzymatique de compétition (cELISA) faisant appel à des anticorps monoclonaux des sérums collectés a montré que la prévalence globale pour la Thrace orientale était un peu au-dessus de 8 %. Dans les provinces de Çanakkale, d'Edirne, de K?rklareli et de Tekirda?, la prévalence était respectivement de 18 %, 7 %, 8 % et 6 % tandis qu'Istanbul était indemne de PPCC. Ces résultats montrent que la PPCC est devenue endémique dans l'ensemble de la région et représente un risque potentiel pour les pays avoisinants, c'est-à-dire la Grèce et la Bulgarie. Jusqu'en 2015, Mccp a été régulièrement détectée dans les échantillons de poumon prélevés chez des chèvres suspectées infectées mais depuis cette date aucun échantillon clinique n'a été testé positif.


En 2002 se detectó por primera vez la pleuroneumonía contagiosa caprina en el continente europeo, a raíz de una serie de brotes de enfermedad respiratoria de inusitada gravedad que afectaron a cabras de la región turca de Tracia. Empleando técnicas serológicas, bacteriológicas y de biología molecular, se detectó en muchos rebaños infectados de toda la región la presencia del agente causal, Mycoplasma capricolum subespecie capripneumoniae (Mccp). Sin embargo, se desconoce el alcance de la infección, porque en los años transcurridos desde entonces no se han reunido datos cuantitativos sobre la prevalencia y distribución de la enfermedad. Por consiguiente en 2014, a partir de una población de más de 167.000 cabras de la región, se obtuvo por muestreo multietápico una muestra aleatoria de 2.400 ejemplares, a los que se extrajeron muestras de suero que fueron sometidas a un ensayo inmunoenzimático de competición (ELISAc) con anticuerpos monoclonales. Se calculó que la prevalencia global de pleuroneumonía contagiosa caprina en Tracia era algo superior al 8%. Por provincias, la prevalencia resultó de alrededor de un 18%, un 7%, un 8% y un 6% en las provincias de Çanakkale, Edirne, K?rklareli y Tekirda?, respectivamente, mientras que la provincia de Estambul resultó estar libre de la infección. Estos resultados demostraron que la enfermedad se ha extendido por toda la región, ha cobrado carácter endémico y puede amenazar a los países vecinos, como Grecia y Bulgaria. Hasta 2015 se detectó regularmente la presencia de Mccp en muestras pulmonares de cabras sospechosas, pero desde entonces no se ha vuelto a observar tal cosa en ninguna muestra clínica.


Subject(s)
Goat Diseases , Pleuropneumonia, Contagious , Animals , Bulgaria , Goats , Greece , Surveys and Questionnaires , Turkey
4.
BMC Vet Res ; 13(1): 149, 2017 May 30.
Article in English | MEDLINE | ID: mdl-28558768

ABSTRACT

BACKGROUND: Little is known about the occurrence of important diseases of ruminants in Afghanistan because of the conflict affecting the country over the last 40 years. To address this discrepancy, ruminant herds in Afghanistan were screened for OIE-listed mycoplasma diseases, contagious bovine (CBPP) and caprine pleuropneumonias (CCPP). RESULTS: Of the 825 samples from 24 provinces tested for serological evidence of CBPP caused by Mycoplasma mycoides subsp.mycoides, 20 (3.4%) had ELISA values greater than the positive threshold of 50% though all were less than 55%. Repeat testing of these suspect sera gave values below 50. A smaller number of sera (330) from cattle in nine provinces were also tested by the rapid latex agglutination test (LAT) for CBPP, 10 of which were considered suspect. However, no positive bands were seen when immunoblotting was carried out on all sera that gave suspect results. Serological evidence of Mycoplasma bovis was detected in half of 28 herds in eight provinces. The cause of CCPP, M. capricolum subsp. capripneumoniae was not detected in any of the 107 nasal swabs and lung tissue collected from goats in seven provinces though sample handling and storage were not optimal. However, strong serological evidence was detected in goat herds in several villages near Kabul some of which were over 50% seropositive by LAT and ELISAs for CCPP; immunoblotting confirmed positive results on a selection of these sera. CONCLUSIONS: The data presented here provide a first assessment of the occurrence of the two OIE listed mycoplasma diseases in Afghanistan. From the results of the testing bovine sera from the majority of provinces there is no evidence of the presence of CBPP in Afghanistan. However the samples tested represented only 0.03% of the cattle population so a larger survey is required to confirm these findings. Serological, but not bacterial, evidence was produced during this investigation to show that CCPP is highly likely to be present in parts of Afghanistan.


Subject(s)
Cattle Diseases/microbiology , Goat Diseases/microbiology , Mycoplasma Infections/veterinary , Afghanistan , Animals , Cattle , Cattle Diseases/diagnosis , Female , Goat Diseases/diagnosis , Goats , Male , Mycoplasma Infections/diagnosis , Pleuropneumonia, Contagious/diagnosis , Pleuropneumonia, Contagious/microbiology , Ruminants
6.
Int J Surg ; 32: 143-9, 2016 Aug.
Article in English | MEDLINE | ID: mdl-27392718

ABSTRACT

INTRODUCTION: Emergency general surgery (EGS) is responsible for 80-90% of surgical in-hospital deaths and the early management of these unwell patients is critical to improving outcomes. Unfortunately care for EGS patients is often fragmented and important care processes are frequently omitted. METHODS: This study aimed to define a group of important processes during EGS admission and assess their reliability. Literature review and semi-structured interviews were used to define a draft list of processes, which was refined and validated using the Delphi consensus methodology. A prospective cohort study of the 22 included processes was performed in 315 patients across 5 acute hospitals. RESULTS: Prospective study of the 22 selected processes demonstrated omission of 1130/5668 (19.9%) processes. Only 6 (1.9%) patients had all relevant processes performed correctly. Administration of oxygen to hypoxic patients (82/129, 64%), consultant review (202/313, 65%) and administration of antibiotics within 3 h for patients with severe sepsis (41/60, 68%) were performed particularly poorly. There were significant differences in the mean number of omissions per patient between hospitals ( ANOVA: F = 11.008, p < 0.001) and this was strongly correlated with hospitals' median length of stay (Spearman's rho = 0.975, p = 0.005). CONCLUSIONS: Reliability of admissions processes in this study was poor, with significant variability between hospitals. It is likely that improvements in process reliability would enhance EGS patients' outcomes. This will require engagement of the entire surgical team and the implementation of multiple interventions to improve the effectiveness of the admission phase of care.


Subject(s)
Emergency Service, Hospital/standards , Emergency Treatment/mortality , Outcome Assessment, Health Care , Patient Admission , Surgical Procedures, Operative/statistics & numerical data , Cohort Studies , Emergency Treatment/statistics & numerical data , Female , Humans , Length of Stay , London , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Retrospective Studies , State Medicine
8.
Antimicrob Agents Chemother ; 59(2): 796-802, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25403668

ABSTRACT

Mycoplasma bovis isolates with decreased susceptibilities to tetracyclines are increasingly reported worldwide. The acquired molecular mechanisms associated with this phenomenon were investigated in 70 clinical isolates of M. bovis. Sequence analysis of the two 16S rRNA-encoding genes (rrs3 and rrs4 alleles) containing the primary binding pocket for tetracycline (Tet-1 site) was performed on isolates with tetracycline hydrochloride MICs of 0.125 to 16 µg/ml. Mutations at positions A965T, A967T/C (Escherichia coli numbering) of helix 31, U1199C of helix 34, and G1058A/C were identified. Decreased susceptibilities to tetracycline (MICs, ≥2 µg/ml) were associated with mutations present at two (A965 and A967) or three positions (A965, A967, and G1058) of the two rrs alleles. No tet(M), tet(O), or tet(L) determinants were found in the genome of any of the 70 M. bovis isolates. The data presented correlate (P<0.0001) the mutations identified in the Tet-1 site of clinical isolates of M. bovis with decreased susceptibility to tetracycline.


Subject(s)
Anti-Bacterial Agents/pharmacology , Mycoplasma bovis/genetics , Tetracycline Resistance/genetics , Tetracycline/pharmacology , Microbial Sensitivity Tests , Mutation , Mycoplasma bovis/drug effects , RNA, Ribosomal, 16S/genetics , Sequence Analysis, DNA
9.
J Clin Microbiol ; 53(3): 789-94, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25540400

ABSTRACT

Mycoplasma bovis is a major bovine pathogen associated with bovine respiratory disease complex and is responsible for substantial economic losses worldwide. M. bovis is also associated with other clinical presentations in cattle, including mastitis, otitis, arthritis, and reproductive disorders. To gain a better understanding of the genetic diversity of this pathogen, a multilocus sequence typing (MLST) scheme was developed and applied to the characterization of 137 M. bovis isolates from diverse geographical origins, obtained from healthy or clinically infected cattle. After in silico analysis, a final set of 7 housekeeping genes was selected (dnaA, metS, recA, tufA, atpA, rpoD, and tkt). MLST analysis demonstrated the presence of 35 different sequence types (STs) distributed in two main clonal complexes (CCs), defined at the double-locus variant level, namely, CC1, which included most of the British and German isolates, and CC2, which was a more heterogeneous and geographically distant group of isolates, including European, Asian, and Australian samples. Index of association analysis confirmed the clonal nature of the investigated M. bovis population, based on MLST data. This scheme has demonstrated high discriminatory power, with the analysis showing the presence of genetically distant and divergent clusters of isolates predominantly associated with geographical origins.


Subject(s)
Cattle Diseases/microbiology , Cluster Analysis , Genetic Variation , Multilocus Sequence Typing , Mycoplasma Infections/veterinary , Mycoplasma bovis/classification , Mycoplasma bovis/isolation & purification , Animals , Cattle , Cattle Diseases/epidemiology , Genes, Bacterial , Genes, Essential , Genotype , Global Health , Molecular Epidemiology , Molecular Sequence Data , Mycoplasma Infections/epidemiology , Mycoplasma Infections/microbiology , Mycoplasma bovis/genetics , Phylogeography
11.
Avian Dis ; 58(2): 323-5, 2014 Jun.
Article in English | MEDLINE | ID: mdl-25055642

ABSTRACT

Mycoplasma iowae, an occasional pathogen of turkeys, was isolated for the first time from captive grey partridges (Perdix perdix). Clinical signs including respiratory and intestinal disorder were seen in birds of all ages but mainly in those kept housed during rearing. Mortality rates averaged over 20% during the year. Treatment with antibiotics and antiparasitic drugs produced only a transient improvement in condition. The gross pathology findings included poor body growth, lack of development of the breast muscles, abnormalities in the keel development, and bone fragility. Some birds showed infraorbital sinusitis with serous or fibrinous exudates and catarrhal tracheitis, while others presented serofibrinous airsacculitis and splenomegaly. Laboratory investigations revealed pure cultures of M. iowae in the gut as well as sinus and air sacs. While other organisms such as coccidia, Trichomonas, Escherichia coli, Clostridium perfringens, and Aspergillus spp. were detected, the similarity of the disease with that seen in turkeys infected with M. iowae strongly suggests that this mycoplasma may be the primary pathogen here. The presence of M. iowae in game birds commonly released into the wild could have serious implications particularly in areas where industrial poultry farms are concentrated.


Subject(s)
Galliformes , Mycoplasma Infections/veterinary , Mycoplasma iowae/isolation & purification , Poultry Diseases/pathology , Animals , Denaturing Gradient Gel Electrophoresis/veterinary , Fluorescent Antibody Technique, Indirect/veterinary , Italy/epidemiology , Molecular Sequence Data , Mycoplasma Infections/microbiology , Mycoplasma Infections/mortality , Mycoplasma Infections/pathology , Mycoplasma iowae/genetics , Mycoplasma iowae/metabolism , Pneumonia/microbiology , Pneumonia/mortality , Pneumonia/pathology , Pneumonia/veterinary , Polymerase Chain Reaction/veterinary , Poultry Diseases/microbiology , Poultry Diseases/mortality , RNA, Ribosomal, 16S/genetics , RNA, Ribosomal, 16S/metabolism , Sequence Analysis, DNA/veterinary , Tracheitis/microbiology , Tracheitis/mortality , Tracheitis/pathology , Tracheitis/veterinary
12.
Surg Endosc ; 27(10): 3520-9, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23588710

ABSTRACT

PURPOSE: This review summarizes the published methods of colonic EFTR, examining data on feasibility and safety. Due to the introduction of bowel cancer screening programs, there is an increasing incidence of complex colonic polyps and early colonic cancer that requires segmental colectomy. Traditional radical surgery is associated with significant morbidity, and there is a need for alternative treatments. METHODS: Systematic literature search identified articles describing EFTR techniques of colon, published between 1990 and 2012. Complication rates, anastomotic bursting pressures, procedure duration, specimen size and quality, and postmortem findings were analyzed. RESULTS: Five research groups reported four EFTR techniques using endoscopic stapling devices, T-tags, compression closure, or laparoscopic assistance for defect closure before or after specimen resection. A total of 113 procedures were performed in 99 porcine models, with an overall success rate of 89 and 4 % mortality. The intraoperative complication rate was 22 % (0-67 %). Post-resection closure methods more commonly resulted in failure to close the defect (5-55 %) and a high incidence of abnormal findings at postmortem examination (84 %). Significant heterogeneity was observed in procedure duration (median or mean 3-233 min) and size of the excised specimen (median or mean 1.7-3.6 cm). Anastomotic bursting pressures and specimen quality were poorly documented. CONCLUSIONS: The technique of EFTR is developing, but the inability to close the resection defect reliably is a major obstacle. The review highlights the challenges that need to be addressed in future preclinical studies.


Subject(s)
Colectomy/methods , Colonic Neoplasms/surgery , Colonoscopy/methods , Laparoscopy/methods , Anastomotic Leak , Animals , Colectomy/instrumentation , Colonic Polyps/surgery , Colonoscopes , Colonoscopy/adverse effects , Equipment Design , Feasibility Studies , Humans , Models, Animal , Postoperative Complications/etiology , Surgical Staplers , Surgical Stapling/methods , Swine , Wound Closure Techniques/instrumentation
13.
J Appl Microbiol ; 114(6): 1575-81, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23445345

ABSTRACT

AIM: To isolate and characterize strains of Mycoplasma agalactiae from bulk tank and silo ewes' milk. METHODS AND RESULTS: Thirteen mycoplasma isolates were obtained from samples of sheep milk taken from bulk tank and large silos and identified as Myc. agalactiae by PCR-DGGE. The isolates were typed by pulsed field gel electrophoresis (PFGE), SDS-PAGE and immunoblot. The in vitro activity of 13 antimicrobials of veterinary interest was tested against these isolates. Results showed that the most effective compounds against Myc. agalactiae in vitro were clindamycin, an antibiotic not previously described as a suitable contagious agalactia (CA) treatment, with Minimum Inhibitory Concentration (MIC) values of <0·12 µg ml(-1) , and quinolones, with MIC values <0·12-0·5 µg ml(-1) , which are used as standard treatments against CA. CONCLUSIONS: Based on the in vitro assay, clindamycin, quinolones, tylosin and tilmicosin would be appropriate antimicrobials for CA treatment. The isolates were mostly resistant to erythromycin, indicating that it would not be a suitable choice for therapy. The isolates showed common molecular and protein profiles by PFGE and SDS-PAGE, with minor differences observed by immunoblot analysis, suggesting a clonal relationship among them. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrated the importance of the appropriate selection of antimicrobials for treatment of CA.


Subject(s)
Milk/microbiology , Mycoplasma agalactiae/drug effects , Animals , Anti-Bacterial Agents/pharmacology , Electrophoresis, Gel, Pulsed-Field , Electrophoresis, Polyacrylamide Gel , Female , Microbial Sensitivity Tests , Mycoplasma agalactiae/genetics , Mycoplasma agalactiae/isolation & purification , Sheep , Spain
14.
Ann Surg ; 257(1): 1-5, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23044786

ABSTRACT

OBJECTIVE: To investigate the nature of process failures in postoperative care, to assess their frequency and preventability, and to explore their relationship to adverse events. BACKGROUND: Adverse events are common and are frequently caused by failures in the process of care. These processes are often evaluated independently using clinical audit. There is little understanding of process failures in terms of their overall frequency, relative risk, and cumulative effect on the surgical patient. METHODS: Patients were observed daily from the first postoperative day until discharge by an independent surgeon. Field notes on the circumstances surrounding any nonroutine or atypical event were recorded. Field notes were assessed by 2 surgeons to identify failures in the process of care. Preventability, the degree of harm caused to the patient, and the underlying etiology of process failures were evaluated by 2 independent surgeons. RESULTS: Fifty patients undergoing major elective general surgery were observed for a total of 659 days of postoperative care. A total of 256 process failures were identified, of which 85% were preventable and 51% directly led to patient harm. Process failures occurred in all aspects of care, the most frequent being medication prescribing and administration, management of lines, tubes, and drains, and pain control interventions. Process failures accounted for 57% of all preventable adverse events. Communication failures and delays were the main etiologies, leading to 54% of process failures. CONCLUSIONS: Process failures are common in postoperative care, are highly preventable, and frequently cause harm to patients. Interventions to prevent process failures will improve the reliability of surgical postoperative care and have the potential to reduce hospital stay.


Subject(s)
Digestive System Surgical Procedures , Elective Surgical Procedures , Medical Errors/statistics & numerical data , Outcome and Process Assessment, Health Care , Postoperative Care/standards , Adult , Aged , Aged, 80 and over , Female , General Surgery/standards , Hospitals, Teaching/standards , Hospitals, Teaching/statistics & numerical data , Hospitals, Urban/standards , Hospitals, Urban/statistics & numerical data , Humans , Interprofessional Relations , London , Male , Medical Errors/adverse effects , Medical Errors/prevention & control , Middle Aged , Patient Safety , Postoperative Care/adverse effects , Postoperative Care/methods , Postoperative Care/statistics & numerical data , Prospective Studies
15.
Ann Surg ; 258(2): 370-5, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23222032

ABSTRACT

OBJECTIVE: To develop guidelines for a faculty training program in nontechnical skill assessment in surgery. BACKGROUND: Nontechnical skills in the operating room are critical for patient safety. The successful integration of these skills into workplace-based assessment is dependent upon the availability of faculty who are able to teach and assess them. At present, no guidelines exist regarding the training requirements for such faculty in surgical contexts. METHODS: The development of the guidelines was carried out in several stages: stage 1-a detailed literature review on current training for nontechnical skill assessors; stage 2-semistructured interviews with a multidisciplinary panel (consisting of clinicians and psychologists/human factors specialists) of experts in surgical nontechnical skills; and stage 3-interview findings fed into an Expert Consensus Panel (ECP) Delphi approach to establish consensus regarding training requirements for faculty assessing nontechnical skills in surgery. RESULTS: The ECP agreed that training in nontechnical skill assessment should be delivered by a multidisciplinary team consisting of clinicians and psychologists/human factors specialists. The ECP reached consensus regarding who should be targeted to be trained as faculty (including proficiency and revalidation requirements). Consensus was reached on 7 essential training program content elements (including training in providing feedback/debriefing) and 8 essential methods of evaluating the effectiveness of a "train-the-trainers" program. CONCLUSIONS: This study provides evidence-based guidelines that can be used to guide the development and evaluation of programs to educate faculty in the training and assessment of nontechnical skills. Uptake of these guidelines could accelerate the development of surgical expertise required for safe and high-quality patient care.


Subject(s)
Clinical Competence , Education, Medical, Continuing/standards , Education, Medical, Graduate , Faculty, Medical , General Surgery/education , Delphi Technique , Education, Medical, Continuing/methods , Humans , Interviews as Topic , Program Development/standards , Program Evaluation/standards , United Kingdom
16.
Vet Rec ; 171(2): 45, 2012 Jul 14.
Article in English | MEDLINE | ID: mdl-22735987

ABSTRACT

Mycoplasma bovis and Mycoplasma mycoides subspecies mycoides small colony (MmmSC) are causes of bovine mycoplasmosis and contagious bovine pleuropneumonia (CBPP), respectively, and are responsible for serious economic losses in cattle around the world. CBPP was last reported in Poland in 1939 but bovine mycoplasmosis is believed to be endemic. A survey of 3670 serum samples for antibodies to M bovis and MmmSC from 361 herds in 16 Polish provinces Poland between 2007 and 2010 found no evidence of CBPP. The seroprevalence of M bovis, however, appeared high with 76.7 per cent of samples giving a positive reaction in the ELISA test, which did not appear to reflect the clinical disease status of the cattle. Adjusting the sensitivity of the test reduced the prevalence to 28.2 per cent and reflects the levels reported in other European countries.


Subject(s)
Antibodies, Bacterial/blood , Cattle Diseases/epidemiology , Mycoplasma Infections/veterinary , Mycoplasma bovis/immunology , Mycoplasma mycoides/immunology , Pleuropneumonia, Contagious/epidemiology , Animals , Cattle , Enzyme-Linked Immunosorbent Assay/veterinary , Female , Male , Mycoplasma Infections/epidemiology , Poland/epidemiology , Seroepidemiologic Studies
17.
Int J Surg ; 10(7): 355-9, 2012.
Article in English | MEDLINE | ID: mdl-22641122

ABSTRACT

BACKGROUND: Clinical handover (handoff, sign out) is frequently implicated as a cause of adverse events in hospitalised patients. Complex social interactions such as handover are subject to the teamwork skills of the participants and there is increasing evidence that the quality of teamwork in handover affects outcome. Teamwork skills have been assessed in one-to-one handovers but the applicability of these measurement tools to healthcare team shift handovers remains unproven. This study aimed to assess the feasibility of measurement of teamwork skills in shift handover and the applicability of adapted teamwork skills rating scales to a shift handover environment. METHODS: Morning surgical shift handovers were assessed for completeness of information transfer, duration, interruptions and handover attendance. Handover teamwork skills were evaluated using two validated rating scales, adapted from one-to-one handovers and intra-operative teamwork skill measurement. RESULTS: 50 handovers, including 306 patients were observed. Communication checklist completion was 97% but the quality of teamwork skills varied widely between handovers. There was very good concurrent validity between the two teamwork skill rating scales (Spearman's rho = 0.67, p < 0.001). There was no significant correlation between content completion, duration, interruptions or attendance and teamwork skill ratings. CONCLUSIONS: Teamwork skills vary widely between handovers and can be consistently scored using both rating scales. It is feasible to use adapted teamwork skill rating scales in shift handover and they appear to measure different constructs to traditional handover measures such as interruptions and communication checklist completion. The assessment of teamwork skills is a necessary complement to the assessment of completeness of information transfer when evaluating the overall quality of handover.


Subject(s)
Continuity of Patient Care/standards , Patient Care Team/standards , Patient Handoff/standards , Surgery Department, Hospital/standards , Hospitalization , Humans , Information Dissemination , Perioperative Care/standards , Prospective Studies , Workforce
19.
Int J Syst Evol Microbiol ; 62(Pt 6): 1321-1325, 2012 Jun.
Article in English | MEDLINE | ID: mdl-21828019

ABSTRACT

Six strains with the typical characteristics of mycoplasmas were isolated from the tracheae of six Canarian Egyptian vultures (Neophron percnopterus majorensis). The results of biochemical, serological and molecular genetic studies showed that the isolates were nearly identical and that they could be considered as representing a novel species of the genus Mycoplasma. Colonies possessed the typical fried-egg appearance and electron micrographs revealed a pleomorphic cellular morphology with the lack of a cell wall. The isolates hydrolysed arginine and required sterol for growth but did not ferment glucose or hydrolyse urea. We propose that the isolates be assigned to a novel species,Mycoplasma neophronis sp. nov. The type strain is G.A.(T) ( = DSM 24097(T) = ATCC BAA-2157(T)). The antiserum of strain G.A.(T) has been deposited in the Mollicutes collection at Purdue University (Indiana, USA).


Subject(s)
Falconiformes/microbiology , Larynx/microbiology , Mycoplasma/classification , Mycoplasma/isolation & purification , Animals , DNA, Bacterial/genetics , Molecular Sequence Data , Mycoplasma/genetics , Phylogeny , RNA, Ribosomal, 16S/genetics
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