Operation Safe Haven: an evaluation of health surveillance and monitoring in an acute setting

From May to June 1999, 3,920 ethnic Albanians from Kosovo arrived in Australia as part of Operation Safe Haven. These people were evacuated from refugee camps in the former Yugoslav Republic of Macedonia. Initial processing in Australia occurred at East Hills Reception Centre, and accommodation for the duration of stay was provided in eight Haven Centres in five States. The arrival of a large number of refugees in a short time frame is unprecedented in Australia. A health surveillance system was developed and critical health data were collected to assess health status and needs, plan care, monitor for potential outbreaks of communicable diseases, track service use, to meet international reporting requirements and document our response to this crisis. In this article the health surveillance system is evaluated and suggestions are offered for the formulation of specific guidelines necessary for health surveillance in acute settings.

Evaluating the potential for opportunistic vaccination in a Northern Territory hospital

OBJECTIVE

To evaluate the potential for opportunistic vaccination and a simple intervention aimed at improving vaccination coverage for children in hospital.

METHODS

Hospital records were reviewed for children under 7 years, discharged from paediatric wards (PW) and the emergency department (ED) for 4 weeks before and after an intervention (423 and 446 children, respectively). This comprised the education of staff and the introduction of prompts to record vaccination status.

RESULTS

Documentation of vaccination status increased in the PW (63-90%) and the ED (24-46%), as did the adequacy of detail recorded (51-77% and 8-36%, respectively). Opportunistic vaccination increased from zero of 84 opportunities during the first audit to six of 139 following the intervention. All but one vaccine was given in the PW. Opportunistic vaccination improved when documentation identified a need for vaccination (P = 0. 02).

CONCLUSION

There were numerous missed opportunities to vaccinate children in hospital, especially in the ED. Simple prompts improved documentation of vaccination status and the detail of information recorded. Despite improved documentation, opportunistic vaccination failed to improve in the ED. Improving documentation of vaccination status is not sufficient in itself to improve opportunistic vaccination.

A South Australian Salmonella Mbandaka outbreak investigation using a database to select controls

Between April and June 1996, 15 persons with Salmonella enterica serovar Mbandaka infection were reported in South Australia (population 1.6 million) compared with 12 over the previous five years. To identify a possible source for the infections a case control study was conducted.

METHODS

Trained interviewers asked 15 cases and 45 controls about their consumption of 105 foods. Controls were matched to case residential location and age. They were selected from a previously constructed database of 3,014 randomly selected South Australian households.

RESULTS

Thirteen of the 15 cases ate 'generic' or 'retail store' brands of peanut butter produced by the same factory in another state, compared with five of the 45 controls (p < 0.01). Salmonella Mbandaka was isolated from three opened jars of peanut butter from case households, and from three unopened jars from retail outlets. Further investigation implicated roasted peanuts from a third Australian state as the source of the Salmonella contamination.

DISCUSSION

This is the first recorded outbreak of salmonellosis resulting from the consumption of peanut butter. The SA outbreak investigation comprised a matched case control study to identify possible common food sources. Such investigations need be conducted rapidly to maximise public health benefits, and the utility of selecting controls from a population based database can improve timeliness.

Community outbreak of psittacosis in a rural Australian town

BACKGROUND

Health authorities in Victoria, Australia were notified of three men from a rural town with atypical pneumonia, admitted to hospital over 8 days. Initial serological testing suggested Chlamydia psittaci as the cause. We did a case-control study to find risk factors for psittacosis.

METHODS

We searched for cases of pneumonia or severe flu-like illness through family physicians and the regional hospital. We selected three controls per case from the region's electoral roll. We collected blood for serological tests and administered questionnaires to all cases and controls.

FINDINGS

We found 16 cases of psittacosis and one died. Most cases were clustered within a small geographical area, with a median age of 58 years (range 23-76), 15 (94%) of whom were male. Keeping, handling, or feeding domestic or wild birds was not associated with illness. Cases spent a median of 17.5 h per week in their garden, compared with a median of 5.2 h for controls (p=0.04) and were more likely to have mowed lawns during the 3 weeks before onset of illness than controls (odds ratio 4.81 [95% CI 1.08-33.37]).

INTERPRETATION

We showed that psittacosis outbreaks are not limited to direct contact with birds and pose new challenges for disease control. Modifications may be needed to work outdoors to decrease the risk of psittacosis.

A prolonged outbreak of Campylobacter infection at a training facility

Campylobacter outbreaks are rarely detected despite Campylobacter being the most common food-borne illness notified to public health authorities. We report a prolonged outbreak of Campylobacter occurring over a three month period at a training facility. Seventy-eight cases were detected, 16 of which were confirmed Campylobacter infections. In seven affected groups of people using the facility, the attack rate ranged between 19% and 67%. An investigation of one sporting group showed that illness was associated with consumption of cucumber served at a self-serve salad bar. Six people attending the facility in other weeks also reported illness after eating only at the salad bar. Transmission of Campylobacter ceased after changes were instituted to food preparation and storage in the facility kitchen.

Hypoplasia of the epiglottis: case report and review

We report an infant born with a hypoplastic epiglottis and present the first in vivo photograph of the condition. Absence or hypoplasia of the epiglottis is a rare anomaly. Previously reported cases either died shortly after birth due to multiple congenital anomalies or details of the outcome were lacking. The clinical effects of hypoplastic epiglottis are discussed.

Clinical features that differentiate hantavirus pulmonary syndrome from three other acute respiratory illnesses

To elucidate the early clinical characteristics of hantavirus pulmonary syndrome (HPS), we compared the clinical features of 24 cases of HPS with those of cases of bacteremic pneumococcal pneumonia (n = 30), influenza (n = 33), or unexplained adult respiratory distress syndrome (ARDS, n = 21). On admission, patients with HPS were less likely than outpatients with influenza to have reported sore throat (OR = 0.02, P < .01) and cough (OR = 0.1, P = .01) and were less likely than patients with pneumococcal pneumonia to have lobar infiltrates detected by chest roentgenography (OR = 0, P < .01). Multivariate discriminant analysis revealed that three clinical characteristics at admission (dizziness, nausea or vomiting, and absence of cough) and three initial laboratory abnormalities (low platelet count, low serum bicarbonate level, and elevated hematocrit level) served to identify all patients with HPS and to exclude HPS in at least 80% of patients with unexplained ARDS. These findings warrant further study and should facilitate the early recognition of patients with HPS, who may benefit from early critical-care intervention.

Laryngoscopic diagnosis of laryngeal sarcoid

Sarcoidosis is usually a multisystem granulomatous disease, and it sometimes affects the larynx and causes symptoms of dysphonia, dyspnea, and dysphagia. Laryngeal sarcoid has a characteristic appearance at direct or indirect laryngoscopy: the supraglottic tissues are symmetrically affected with a pale, diffusely swollen appearance somewhat like that of epiglottitis. Five cases of laryngeal sarcoid are presented. Three photographs taken at direct laryngoscopy, and one at indirect laryngoscopy, document and emphasize the typical appearance of the supraglottic tissues. The appearance of this uncommon condition is sufficiently characteristic to suggest the diagnosis, which can finally be confirmed only by biopsy.

User-space protocols deliver high performance to applications on a low-cost Gb/s LAN

Two important questions in high-speed networking are firstly, how to provide Gbit/s networking at low cost and secondly, how to provide a flexible low-level network interface so that applications can control their data from the instant it arrives.

We describe some work that addresses both of these questions. The Jetstream Gbit/s LAN is an experimental, low-cost network interface that provides the services required by delay-sensitive traffic as well as meeting the performance needs of current applications. Jetstream is a combination of traditional shared-medium LAN technology and more recent ATM cell- and switch-based technology.

Jetstream frames contain a channel identifier so that the network driver can immediately associate an incoming frame with its application. We have developed such a driver that enables applications to control how their data should be managed without the need to first move the data into the application's address space. Consequently, applications can elect to read just a part of a frame and then instruct the driver to move the remainder directly to its destination. Individual channels can elect to receive frames that have failed their CRC, while applications can specify frame-drop policies on a per-channel basis.

Measured results show that both kernel- and user-space protocols can achieve very good throughput: applications using both TCP and our own reliable byte-stream protocol have demonstrated throughputs in excess of 200 Mbit/s. The benefits of running protocols in user-space are well known- the drawback has often been a severe penalty in the performance achieved. In this paper we show that it is possible to have the best of both worlds.

The correlation of placental protein 14 concentrations in uterine flushing and endometrial morphology in the peri-implantation period

The relationship between the concentrations of placental protein 14 (PP14) in uterine flushing and the endometrial morphology in the mid-luteal phase was assessed in a prospectively designed study involving the precise timing of all samples by the luteinizing hormone (LH) surge. A total of 29 regularly cycling women with unexplained infertility or recurrent miscarriage were studied. To flush the uterine cavity, 10 ml of physiological saline solution was used immediately prior to sampling of an endometrial specimen for morphological study, in the mid-luteal phase. PP14 concentrations were measured by radioimmunoassay in uterine flushings and plasma samples; the endometrium was assessed by the use of histological dating criteria and morphometric techniques. PP14 levels in uterine flushings were correlated with endometrial dating and volume fraction measurement of the glands. They were consistently below the sensitivity of the assay with histological dating of < day LH +5, or when the glandular lumen occupied < 20% of the gland. In contrast, PP14 concentrations in plasma were not related to histological dating or morphometric analyses, and did not differ in patients with normal endometrial development (20.8 ng/ml) and in those with retarded endometrial development (22.5 ng/ml). The presence of detectable concentrations of PP14 in uterine flushing was significantly associated with normal histological dating. Uterine flushing may therefore provide a reliable, non-invasive alternative to endometrial biopsy in the evaluation of endometrial function in the peri-implantation period.

Concentration of endometrial protein PP14 in uterine flushings throughout the menstrual cycle in normal, fertile women

OBJECTIVE

To determine the variation in concentration of endometrial protein PP14 in uterine flushings throughout the menstrual cycle comparing this to concentrations in plasma samples.

DESIGN

Precise timing of all samples by the luteinising hormone surge.

SETTING

Jessop Hospital for Women, Sheffield.

SUBJECTS

Twenty-three regularly cycling, previously fertile volunteer women.

INTERVENTIONS

Observational study; 10 ml of physiological saline was used to flush the uterine cavity once or serially in the cycle of the study.

MAIN OUTCOME MEASURES

The measurement of PP14 levels by radioimmunoassay in uterine flushings and plasma samples.

RESULTS

In uterine flushing, PP14 levels were not detectable in significant amounts in the proliferative phase and the early luteal phase; after day LH + 6, the concentration rises rapidly with a doubling time of only 6.6 to 14.6 h in the midluteal phase. In the late luteal phase, the concentrations in uterine flushing were over a hundred times higher than the corresponding plasma samples.

CONCLUSIONS

The measurement of PP14 in uterine flushings is likely to be of greater value than the measurement in plasma samples; it may provide a valuable alternative to the evaluation of endometrial function.

Placental protein 14 levels in uterine flushing and plasma of women with unexplained infertility

OBJECTIVES

To measure concentrations of placental protein 14 (PP14) in uterine flushings and plasma samples obtained from patients with unexplained infertility and to compare the results of those of normal fertile women.

DESIGN

Prospective study.

SETTING

Infertility and gynaecology outpatient clinics at the Jessop Hospital for Women, Sheffield, United Kingdom.

PATIENTS

Sixteen patients with unexplained infertility and 12 normal fertile women who had been previously sterilized.

INTERVENTIONS

Daily monitoring of luteinizing hormone (LH) to detect the LH surge; uterine flushings and blood samples were obtained on days 7, 10, and 12 after the LH surge.

MAIN OUTCOME MEASURES

The measurement of PP14 concentration in uterine flushings and plasma samples throughout the luteal phase.

RESULTS

Levels of PP14 in uterine flushings of patients with unexplained infertility were significantly lower than those of normal fertile women on days LH +10 and LH +12. No significant differences were observed between the two groups in PP14 levels in uterine flushings on day LH +7 and plasma samples on days LH +7, LH +10, and LH +12.

CONCLUSIONS

Patients with unexplained infertility have reduced concentrations of PP14 in uterine flushings but not in plasma samples as compared with normal fertile women. Placental protein 14 measurement in uterine flushings may be a more valuable method of assessing endometrial function in infertile patients than plasma levels of the protein.

[Integration of a nursing model into a local community service center]

Four years ago, maternal/child health nurses from the Metro CLSC in Montreal found themselves in a crisis situation. They were unable to evaluate their work--which consisted of varying tasks and the need for these nurses to be everywhere at the same time. A need to reflect on the situation prompted the team to meet for three hours twice monthly to analyze the problems and establish a plan of action. A nurse-counsellor guided the initial process. A post-natal home visit was chosen as an example for discussion. The group conceded that each member of the perinatal team had a different philosophy and nursing approach. The team consisted of nurses of various ages, experiences and educational backgrounds. Some nurses felt more comfortable expressing themselves in English while others preferred French. At times this group diversity hindered the communication of ideas as well as the ability to reach a consensus about required practice changes. The McGill Nursing model from McGill University was chosen and integrated into the team's practice. The author presents this model and outlines it's advantages and disadvantages. She illustrates this model with the use of an ecomap designed by Wright and Leahy (1984). This nursing model addresses the use of forces within each individual as well as the family. Since it takes into account the extended family, it allows a global approach to care. The article focuses on the essential elements of integrating the model, including it's development and how it was accepted by these nurses. According to the author, the process of changing to this model is dynamic and continuous.(ABSTRACT TRUNCATED AT 250 WORDS)

An analysis of the variation of plasma concentrations of placental protein 14 in artificial cycles

OBJECTIVE

To analyze the factors affecting the variation of plasma concentration of placental protein 14 (PP14) in artificial cycles.

DESIGN

The effects of different hormone replacement therapy (HRT) regimens were examined in a crossover design.

SETTING

Jessop Hospital for Women, Sheffield, United Kingdom.

PATIENTS

Eighteen women with premature ovarian failure: 6 associated with Turner's syndrome and 12 with idiopathic premature ovarian failure.

INTERVENTIONS

Four different HRT regimens; 36 study cycles.

MAIN OUTCOME MEASURES

Plasma PP14 concentrations on days 1, 15, 19, and 29 of the artificial cycles.

RESULTS

In cycles treated with a standard HRT, the levels were similar to those of the natural cycle. Subjects with Turner's syndrome did not have elevated PP14 levels, whereas the majority (9/12 [75%]) of those with idiopathic premature ovarian failure had elevated levels on day 29 of the cycle. Levels of PP14 were reduced when either the doses of estradiol valerate were reduced to 1/3 or the doses of progesterone (P) were reduced to 1/5 of the standard HRT.

CONCLUSIONS

Plasma levels of PP14 are dependent not only on P stimulation but also on adequate estrogen priming.

Stationary vs. mapping manometry in evaluating dysphagia

Two methods are used to assess esophageal motility. The mapping technique uses catheter withdrawal at 1 cm steps until the entire esophagus is evaluated. A simpler method is commonly used that involves keeping the catheter stationary for the entire evaluation. We compared these 2 techniques in 30 patients referred for the evaluation of dysphagia. Emphasis was placed on the distal 10 cm of the esophagus because this is the primary location of esophageal motility disorders. There was excellent correlation between techniques for mean distal amplitude (r = 0.945), mean distal duration (r = 0.942), and percentage of non-peristaltic contractions (r = 0.967). The overall manometry diagnosis was similar by both methods in 27 (90%) patients. Three patients had different manometry diagnoses resulting from use of the two techniques. However, the change in diagnosis was only clinically important in one patient in whom the mapping technique identified a segmental motility disorder that had been missed by the stationary technique. Stationary manometry had a 94% sensitivity and 93% specificity rate for identifying motility disorders compared to mapping manometry. We conclude that stationary manometry is a simple and accurate method for evaluating esophageal pressures and distal disorders. Only those patients with normal results of stationary studies may benefit by further mapping to identify rare segmental motility disorders.