Implementation of nutrition risk screening using the Malnutrition Universal Screening Tool across a large metropolitan health service.

BACKGROUND: A standardised nutrition risk screening (NRS) programme with ongoing education is recommended for the successful implementation of NRS. This project aimed to develop and implement a standardised NRS and education process across the adult bed-based services of a large metropolitan health service and to achieve a 75% NRS compliance at 12 months post-implementation. METHODS: A working party of Monash Health (MH) dietitians and a nutrition technician revised an existing NRS medical record form consisting of the Malnutrition Universal Screening Tool and nutrition management guidelines. Nursing staff across six MH hospital sites were educated in the use of this revised form and there was a formalised implementation process. Support from Executive Management, nurse educators and the Nutrition Risk Committee ensured the incorporation of NRS into nursing practice. Compliance audits were conducted pre- and post-implementation. RESULTS: At 12 months post-implementation, organisation-wide NRS compliance reached 34.3%. For those wards that had pre-implementation NRS performed by nursing staff, compliance increased from 7.1% to 37.9% at 12 months (P < 0.001). The improved NRS form is now incorporated into standard nursing practice and NRS is embedded in the organisation's 'Point of Care Audit', which is reported 6-monthly to the Nutrition Risk Committee and site Quality and Safety Committees. CONCLUSIONS: NRS compliance improved at MH with strong governance support and formalised implementation; however, the overall compliance achieved appears to have been affected by the complexity and diversity of multiple healthcare sites. Ongoing education, regular auditing and establishment of NRS routines and ward practices is recommended to further improve compliance.

A method for adjusting gender bias in neonatal tetanus reports in Egypt 1991.

Reports of neonatal tetanus (NT) disease, common in developing countries, often suffers from gender bias because male infants are brought to health facilities while females are attended at home. Using existing health data we applied reasonable assumptions to estimate the true incidence of NT economically. To adjust for gender disparities in national reporting, we ignored the number of female NT cases and doubled the number for males. Governorates with similar demographic risk profiles for NT were assigned to one of six groups. The highest incidence rate within the group was determined and applied to the number of live births represented by the group. Other internal data comparisons were done to support our estimate that the male:female ratio of NT incidence was far less than the reported 412:1. In 1991, the male: female ratio of NT cases was 4.12:1. Decreasing the male: female ratio to 1:1 decreased sensitivity to a 62% estimate. Further adjusting for assumed under-reporting by governorates based on population profiles yielded a reporting sensitivity of 40%. Estimated male and female age-specific NT mortality rates from available data supported the assumption that NT mortality ratios are less than 4.12:1. This report, therefore, describes a unique, economical method to estimate the incidence of a disease assumed to be affected by gender biases in the reporting system. The method relies on two assumptions: that the true NT male:female ratio is close to 1:1 and that populations with similar demographics within a country should have similar incidence rates of NT.

Historical overview of vaccines.

This article focuses on a few significant milestones in the history of vaccination. As the contributions of key investigators, such as Jenner, Pasteur, and Salk were slowly accepted, the developments and discoveries that followed pushed ahead the science of vaccinology. The article also recognizes the accomplishments of the World Health Organization and concludes with a short synopsis of vaccines being developed for the future.

Clostridial bacteremia in the community hospital.

Anaerobic infections are not commonly studied in the community hospital. The aim of this study was to determine demographic factors, the portals of entry and underlying disorders for clostridial bacteremia and to determine whether appropriate (recommended) treatment is effective. Medical records were reviewed for 42 patients with clostridial bacteremia at 1 Florida, USA, hospital and 4 Dayton, Ohio, USA, hospitals. Fourteen (33.3%) of the patients had clostridial micro-organisms that were isolated in cultures with polymicrobial isolates. Only about half of the patients had fever at the onset of their bacteremia and only slightly more than half had elevated leukocyte counts. The most common portals of entry for the micro-organisms were gastrointestinal (42.9%), unknown (35.7%) and skin (16.7%). The most common underlying disorders were advanced malignancy (31.0%), diabetes mellitus (14.3%), none determined (12.0%) and acute cholecystitis (9.5%). The mortality rate was 23.8%. Timely appropriate treatment was started in only about half of the instances. Appropriate (recommended) treatment did not significantly affect survival (p = 0.469). Clostridial infections and bacteremia exist in the community hospital most commonly in severely ill patients. The fact that clostridia are commonly cultured in blood cultures positive for other bacterial pathogens and that appropriate treatment for clostridia did not affect patient survival, call into question the significance and pathogenicity of clostridial organisms. On the other hand, if clostridial bacteremia was not considered in half these patients with bacteremia, it is possible that more indolent clostridial infections are being overlooked.

Interactions of xylazine and acepromazine with oxytocin and the effects of these interactions on intrauterine pressure in normal mares and mares with delayed uterine clearance.

The effects of the sedatives xylazine (predominantly alpha2 agonist) and acepromazine (predominantly alpha1 antagonist) and their influence on intrauterine pressure were measured in four reproductively normal mares and four mares with delayed uterine clearance. Intrauterine pressure was measured in each mare during oestrus for three 100 min periods using an 8-F catheter with three discrete pressure sensors. After 10 min of baseline recording, xylazine, acepromazine or saline was administered i.v. Oxytocin was administered i.v. after a further 30 min, and pressure recordings were continued for 60 min. The pressure changes analysed were: number of uterine contractions; time of onset and duration of the first contraction; and the time at which intrauterine pressure changed from baseline. Data were analysed using the mixed procedure of the Statistical Analysis System. ANOVA detected an effect of treatment (P < 0.0001) and a treatment by group interaction (P < 0.001). Xylazine administration caused a tetanic contraction in all mares. When mares with delayed uterine clearance were sedated with xylazine before administration of oxytocin, the duration of increased intrauterine pressure was longer than that of normal mares (24.87 +/- 2.52 and 15.81 +/- 2.46, respectively; P < 0.0001). Acepromazine administration had no effect on the oxytocin-induced contraction pattern in normal mares, but there was a decrease in the number of contractions in mares with delayed uterine clearance. The enhanced response to alpha-agonists and -antagonists observed in mares with delayed uterine clearance when the drugs were administered before oxytocin may be due to denervation supersensitivity. After mating, sedation of mares with xylazine is preferred to sedation with acepromazine, as xylazine increases uterine contraction time.

Cell surface changes associated with cellular immune reactions in Drosophila.

In Drosophila melanogaster a temperature-induced change in immune competence accompanies cell surface alterations that cause its blood cells to adhere and to encapsulate a parasite. At 29 degrees C the blood cells of the tumorous-lethal (Tuml) mutant show a high degree of immune competence and encapsulate the eggs of the parasitic wasp Leptopilina heterotoma. At 21 degrees C the blood cells are essentially immune incompetent. High percentages of lectin binding cells were found under conditions which potentiated cellular encapsulation responses. Some immune reactive blood cells did not bind lectin. The low percentages of lectin binding cells in susceptible hosts suggest that developing parasites alter the cell surface of the blood cells of immune reactive hosts.