Pre-placement screening for tuberculosis in healthcare workers.

BACKGROUND: Healthcare workers (HCWs) are at occupational risk of contracting and transmitting tuberculosis (TB). Despite national guidance, the optimal process for the pre-placement screening of new entrant HCWs for TB in the UK is not certain, nor the appropriateness of using a one-step interferon gamma release assay (IGRA) screening programme. AIMS: To assess the potential for an IGRA-only TB screening programme for new entrant HCWs, and identify cost savings achieved through this process. METHODS: We conducted a retrospective analysis of IGRA and tuberculin skin tests (TST) within our occupational health service over a 3-year period. HCWs with markedly discordant test results (IGRA negative, TST positive) were followed up to determine whether they developed active TB. We also estimated the yearly cost savings if the existing two-step process was replaced with an IGRA-only programme. RESULTS: Totally, 96/1258 (8%) HCWs had positive IGRA results; 788 TSTs were performed for newly screened IGRA-negative HCWs without Bacille Calmette-Guérin scars, among which 597 (76%) tested negative (TST <6 mm). None of the 10 individuals with grossly discordant test results (TST >15 mm) developed active TB during the study period. We calculated savings of £20,453 if the two-step process was replaced with an IGRA-only programme. CONCLUSIONS: The absence of disease progression in individuals with markedly discordant results in this study suggest that an IGRA-only screening programme for new HCWs in the UK is feasible, and may be safe although our follow-up period was insufficient. Our results also suggest that substantial cost savings can be made by using this programme.

Communication gaps and readmissions to hospital for patients aged 75 years and older: observational study.

OBJECTIVES: (1) To identify communication gaps at hospital discharge for older people who are readmitted within 28 days; (2) to assess the contribution of incomplete discharge information to readmission; (3) to identify measures that might improve communication at hospital discharge. DESIGN: Retrospective case-note review. SETTING: A teaching hospital in Nottingham, UK. SAMPLE: 108 consecutive patients aged 75 and over who were readmitted as an emergency within 28 days of previous discharge MAIN OUTCOME MEASURES: (1) Proportion of patients discharged with insufficient arrangements and/or information for immediate safe continuity of care; (2) proportion of patients with medication management information missing; (3) proportion of readmissions related to incomplete medication management information and proportion of patients for whom this was preventable. RESULTS: Thirty patients (28%) returned within 3 days of discharge, 48 (44%) within 7 days and the remainder within 28 days. Sixty-seven (62%) patients either had no discharge letter or returned before the letter was typed. Documentation of changes in medication was incomplete on two-thirds of all discharge documents. Readmission was considered to be related to medication for 41 (38%) patients and to be preventable for 25 (61%) of these. There were preventable discharge communication gaps, including monitoring information, for 22 (54%) of these patients. CONCLUSION: Incomplete documentation at discharge was common, particularly for medication management. It is likely that communication gaps contributed to many of the preventable adverse events and readmissions.

Effect of megestrol caproate on the reproductive function of laboratory animals.

In vivo experiments on rats and rabbits showed that megestrol caproate, a 17-alpha-hydroxyprogesterone derivative exhibits 10-fold higher gestagenic activity compared to progesterone and possesses no androgenic, anabolic, and estrogenic activities.