Development,implementation and impact of simple patient safety interventions in a university teaching hospital

ObjectiveTo determine the incidence of anesthesia patient safety incidents at a university teaching hospital, develop interventions to address the most common incidents, and determine the effectiveness of these interventions.Study designPre-post intervention observational.AnimalsFour thousand, one hundred forty dogs and cats anesthetized by the anesthesia service.MethodsThe study was divided into two 11.5 month periods. During each period, incidents were logged (e.g. closed adjustable pressure limiting (APL) valve, esophageal intubation, and medication error). At the end of the first period, four countermeasures were incorporated into the service’s protocols: 1) prior to any drug injection, the individual would read out aloud the drug name, patient name, and route of administration; 2) use of a uniquely colored occlusive wrap over arterial catheters; 3) a check box on the anesthesia record labeled “Technician Confirmed Intubation”; 4) a check box on the anesthesia record labeled “Technician Checked OR (operating room)”. The number of patient safety incidents during period 1 and period 2 were compared using Fisher’s Exact Test.ResultsDuring Period 1, there were 74 incidents documented in 2028 patients (3.6%) including 25 medication errors, 20 closed APL valves, and 16 of esophageal intubation. During Period 2, there were 30 incidents documented in 2112 patients (1.4%) including 14 medication errors, 5 closed APL valves, and 4 of esophageal intubation. The proportion of events during Period 2 was significantly smaller than during Period 1 (p < 0.0001).Conclusions and Clinical relevanceImplementation of four simple interventions was associated with a significant decrease in the number of incidents.     

Standing enucleation in the horse: a report of 5 cases

Enucleation was performed in 5 horses under local anesthesia and sedation with the horse standing. Minimal hemorrhage occurred during the surgical procedure, and there were no other reported complications. Standing enucleation is a surgery that is safe to perform in horses.     

High-resolution ultrasonography of xenografted domestic cat ovarian cortex

Transplantation of ovarian tissue has high potential for female gamete conservation. However, optimal timing of oocyte recovery for in vitro maturation and fertilization is still critical. Therefore the aim of the present study was to use high-resolution transcutaneous ultrasonography to monitor follicular development within xenografted ovarian tissue. Ovarian cortex fragments (n=44) from domestic cats were transplanted into athymic nude rats (n=12). Graft development in the animals was assessed weekly by high frequency ultrasound (10-22 MHz) under two different FSH regimes. Blood collection for serum estradiol determination and vaginal smears were performed simultaneously. The xenografts were removed at different time points according to the ultrasound findings. The survival rate of the transplants 4 weeks after surgery was 54.5% and antral follicular growth was observed within 10 grafts from 5 different hosts (8.6 +/- 6.43 follicles per graft). Early follicle antrums could be detected from 0.4 mm onwards. The growth rate of the antral cavity was calculated from weekly measurements (0.56 +/- 0.44 mm per week). Although vaginal cells and estradiol levels followed a cyclic pattern, no correlation was found between follicular diameter, estradiol and keratinized vaginal cells. We recovered 5, 1 and 4 cumulus oocyte complexes from three different individuals during weeks 19, 21, and 23 respectively. Extrusion of a polar body (1 oocyte) and germinal vesicle break down (7 oocytes) indicated progression of maturation after in vitro culture. We conclude that ultrasonography und provided a reliable method to examine xenograft survival and follicular development within the grafts. Furthermore, this technique is suitable for assessment of the efficiency of hormonal treatment and narrowing of the optimal time frame for oocyte retrieval. To our knowledge, this is the first report of the in vivo development of early antral follicles in mammalian species.     

Explaining variation in Brazil nut fruit production

Brazil nut is widely recognized as the cornerstone of the Amazonian extractive economy. Tight linkages between Brazil nut production, regional income, and intact mature forests have thrust this species into focus as a key component of Amazonian conservation and income generation strategies. Nonetheless, a comprehensive synthesis of factors explaining Brazil nut fruit production variation is lacking. We aimed to address this knowledge gap, asking: (1) What are the rates and annual variation of Bertholletia excelsa fruit production at individual and population levels? (2) What factors explain B. excelsa production variation, focusing on spatial and temporal variables, diameter at breast height (dbh), crown attributes, liana loads, and soil attributes? and (3) Does liana cutting affect fruit production?     

Prevalence of feline infectious peritonitis in specific cat breeds

Although known that purebreed cats are more likely to develop feline infectious peritonitis (FIP), previous studies have not examined the prevalence of disease in individual breeds. All cats diagnosed with FIP at a veterinary teaching hospital over a 16-year period were identified. Breed, sex and reproductive status of affected cats were compared to the general cat population and to mixed breed cats evaluated during the same period. As with previous studies sexually intact cats and purebreed cats were significantly more likely to be diagnosed with FIP; males and young cats also had a higher prevalence of disease. Abyssinians, Bengals, Birmans, Himalayans, Ragdolls and Rexes had a significantly higher risk, whereas Burmese, Exotic Shorthairs, Manxes, Persians, Russian Blues and Siamese cats were not at increased risk for development of FIP. Although additional factors doubtlessly influence the relative prevalence of FIP, this study provides additional guidance when prioritizing differentials in ill purebreed cats.     

Evaluating the risk of tick‐borne relapsing fever among occupational cavers—Austin,TX, 2017

Tick‐borne relapsing fever (TBRF) is a potentially serious spirochetal infection caused by certain species of Borrelia and acquired through the bite of Ornithodoros ticks. In 2017, Austin Public Health, Austin, TX, identified five cases of febrile illness among employees who worked in caves. A cross‐sectional serosurvey and interview were conducted for 44 employees at eight organizations that conduct cave‐related work. Antibodies against TBRF‐causing Borrelia were detected in the serum of five participants, four of whom reported recent illness. Seropositive employees entered significantly more caves (Median 25 [SD: 15] versus Median 4 [SD: 16], p = 0.04) than seronegative employees. Six caves were entered more frequently by seropositive employees posing a potentially high risk. Several of these caves were in public use areas and were opened for tours. Education of area healthcare providers about TBRF and prevention recommendations for cavers and the public are advised.     

Symbiosis of Trifolium subterraneum with mycorrhizal fungi and Rhizobium trifolii as affected by ammonium sulphate and nitrification inhibitors

The symbioses between Trifolium subterraneum, mycorrhizal fungi and Rhizohium are affected by (NH₄)₂SO₄ and by the nitrification inhibitors 2-chloro-6 (trichloromethyl) pyridine (N-Serve) and 2-trichloromethyl pyridine (2TMP). At 50 μg · g^?1 soil N-Serve and 2TMP had toxic effects on plant growth, measured as leaf expansion, root length and dry weight. Lower concentrations of N-Serve also produced some toxic symptoms. The addition of (NH₄)₂SO₄ to the soil at 2 and 6 m-equiv NH⁺₄ per pot, resulted in reduced root length and nodulation. Shoot dry weight was reduced at 6 m-equiv NH⁺₄ per pot. In the presence of (NH₄)₂SO₄ the toxic effects of the nitrification inhibitors on plant growth were less.Both nitrification inhibitors reduced development of mycorrhizal entry-points and extent of root colonization (% infection). Percentage infection of the root system was also reduced by (NH₄)₂SO₄. Development of nodules on the lateral roots was increased in the presence of N-Serve at 5 and 15 μ · g^?1. This effect, however, was accompanied by a marked reduction in N₂ase activity. Smaller increases in nodulation were apparent with 2TMP and were associated with variable N₂ase activity.     

In vivo priming heterophil innate immune functions and increasing resistance to Salmonella enteritidis infection in neonatal chickens by immune stimulatory CpG oligodeoxynucleotides

Oligodeoxynucleotides (ODN) containing CpG dinucleotides (CpG-ODN) mimic bacterial DNA and stimulate the innate immune system of vertebrates. Here, we investigated the effects of intraperitoneal (ip) administered CpG-ODN on the innate immune functions of chicken heterophils. Our results demonstrated CpG-ODN-dependent priming of chicken heterophil degranulation and oxidative burst. Heterophils from chickens treated with CpG-ODN exhibited significantly higher (p<0.05) degranulation activity compared to PBS and control ODN (ODN containing no CpG motif) treated groups when stimulated with opsonized Salmonella enterica serovar enteritidis. Similarly, oxidative burst activity, which generates bactericidal reactive oxygen species, was significantly higher (p<0.05) in heterophils from the CpG-ODN treated group than from PBS and control ODN groups when stimulated with formalin-killed S. enteritidis. The priming effects of CpG-ODN on heterophil immune functions continued at least 4 days post-treatment. In the infection study, newly hatched chickens were treated with CpG-ODN, control ODN or PBS for 24h then challenged with oral inoculation of S. enteritidis. A significant reduction (p<0.05) in colonization by S. enteritidis was observed in chickens treated with CpG-ODN. Our study provides evidence that immunostimulatory CpG-ODN potentiates the innate immune responses of heterophils and enhances resistance to infectious pathogens in neonatal chickens.     

Fatty acids and fat-soluble vitamins in salted herring (Clupea harengus) products

The fatty acid composition and contents of fat and fat-soluble vitamins of three salted products prepared from Icelandic herring were analyzed. The effects of storage on the products over their shelf life, 6 or 12 months, were investigated. The average oil content of salted, gutted herring and salted fillets in vacuum remained constant, 17 and 12% of wet weight, respectively. In the pickled product the oil content decreased during the 12 months of storage from 13 to 12%. The composition of the products was typical for herring, the most abundant fatty acids being oleic (18:1n-9), palmitic (16:0), cetoleic (22:1n-11), and gadoleic (20:1n-9) acids. Monounsaturated acids constituted clearly the main group with a proportion of >50% of all fatty acids. Eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3) comprised together >12% of all fatty acids. During storage, some hydrolysis of triacylglycerol (TAG) occurred, causing a slight reduction in practically all esterified fatty acids. In none of the three products was the loss of polyunsaturated fatty acids from TAG greater than the loss of saturated ones, indicating that the loss of EPA and DHA was not due to oxidation. After packing, the average content of vitamins A, D, and E in the products varied between 27 and 87 microg/100 g (wet weight), between 17-28 microg/100 g (wet weight), and between 77-120 microg/100 g (wet weight), respectively. During storage, the level of vitamin A decreased significantly, whereas no loss of vitamin D was observed. The content of vitamin E was low in all products and showed wide variation. When compared to the recommended daily intake, it could be concluded that the products investigated were good and stable sources of long-chain n-3 fatty acids (EPA, DHA) and vitamin D.