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.     

Excavating sponges that are destructive to farmed pearl oysters in Western and Northern Australia

Species of the family Clionaidae (Porifera: Demospongiae) that excavate shell of the silver‐lip pearl oyster, Pinctada maxima, in north Western and Northern Australia are described. Two species belong to the genus Cliona and one species to the closely related genus Pione. Cliona orientalis has only recently been reported from Australia in living and dead coral on the Great Barrier Reef, and this is the first report of this species from north Western and Northern Australia. Cliona dissimilis is reported from Australia for the first time. Pione velans was first described from Shark Bay, Western Australia and this study extends its distribution from Albany, south Western Australia to Port Bremer in the Northern Territory. The most common species found was C. dissimilis. Pione velans and C. orientalis were also present, although the latter species was rare. Cliona dissimilis and P. velans were found to be sexually reproductive in some shells with specimens of C. dissimilis with oocytes in May and P. velans in September 1999. Egg development was synchronous, indicating that the sponges were oviparous and would broadcast gametes in a spawning event.     

Evaluation of Plant and Animal Source Proteins for Replacement of Fish Meal in Practical Diets for the Largemouth Bass Micropterus salmoides

Two feeding trials were conducted with juvenile largemouth bass Micropterus salmoides to evaluate alternative plant and animal source proteins for their ability to replace fish meal in practical diets. The first trial was designed to identify the most promising candidates. The second trial was conducted to evaluate how much of the fish meal could be replaced by those candidates. In Study 1, feed‐trained largemouth bass (3.1 ± 0.7 g) were randomly stocked into 18114‐L glass aquaria at 25 fish per aquarium. Fish were fed one of six experimental diets, each containing approximately 38% crude protein and 10% crude lipid, to apparent satiation twice daily. The control diet (CTL) contained 30% fish meal and 34.5% soybean meal. Diets 2–6 each contained 15% fish meal and at least 34.5% soybean meal with the remainder of the protein made up of either meat and bone meal (MBM), soybean meal (SBM), poultry by‐product meal (PBM), a 50150 mixture of blood meal and corn gluten meal (BM/CG), or 50150 mixture of hydrolyzed feather meal and soybean meal (FMISBM). There were three replicate aquaria per dietary treatment. After 12 wk, there was no significant difference (P > 0.05) among treatments in survival which averaged 92% overall. Only fish fed the PBM or BM/CG diets had average individual weights and feed conversion efficiencies that were not significantly different (P > 0.05) from the control diet (CTL). In Study 2, the formulation of the control diet (CTL) remained the same. Based on their performance in the first trial, PBM and BM/CG were chosen to now replace 75 or 100% of the fish meal. Fish were stocked at an average weight of 6.9 ± 1.7 g. After 11 wk, fish fed diets containing the BM/CG mixture at both levels were significantly smaller (P 5 0.05) than fish fed other diets and at 100% replacement survival was reduced. Fish fed diets containing poultry meal as the primary protein source performed as well as those fed the control diet (CTL). It appears that PBM can completely replace fish meal in diets for juvenile largemouth bass without adverse effects on growth, feed efficiency, or body composition.     

Evaluation of Canine Red Blood Cells Stored in a Saline, Adenine, and Glucose Solution for 35 Days

An additive solution for the storage of red blood cells was evaluated for use in dogs. Blood collected from 6 dogs was processed into packed red blood cells and stored for 35 days in the additive solution Nutricel (Miles, Inc, Pharmaceutical Division, West Haven, CT). Packed red blood cells stored in citrate-phosphate-dextrose-adenine (CPDA-1; Fenwal Laboratories, Baxter Health Care Corp, Deerfield, IL) also were evaluated for comparison. Red blood cell 2,3-diphosphoglycerate (2,3-DPG) concentration, adenosine triphosphate (ATP) concentration, percentage hemolysis, and pH were determined. The red blood cell post-transfusion viability (PTV) after 35 days of storage was assessed with both single-labeled chromium 51 (⁵¹Cr) and double-labeled technetium 99m/chromium 51 (^99mTc/⁵¹Cr) techniques. Mean ATP concentration and percentage hemolysis of the cells stored in Nutricel were 1.1 μmol/g hemoglobin (Hb) and 0.28% respectively and did not differ significantly (P < .05) from the values of 1.0 μmol/g Hb and 0.33% from the CPDA-1-stored red blood cells. The mean pH of red blood cells stored in Nutricel was 6.19, which was significantly lower than the pH of 6.47 for cells stored in CPDA-1. The mean 2,3-DPG concentration of red blood cells stored in Nutricel was significantly higher at 10.1 μmol/g Hb than the 2,3-DPG concentration of 3.4μmol/g Hb for cells stored in CPDA-1. The mean PTV of canine red blood cells stored in Nutricel for 35 days was 85% with ⁵¹Cr and 90% with ^99mTc/⁵¹Cr. This was significantly higher than the mean PTVs of 38% and 36% for the CPDA-1 stored cells as assessed with ⁵¹Cr and ^99mTc/⁵¹Cr techniques, respectively. It was concluded that 35-day-old canine red blood cells stored in Nutricel are of acceptable quality for transfusion purposes.     

Septic osteitis of the distal phalanx in foals: 22 cases (1995-2002)

OBJECTIVE: To determine the clinical characteristics and outcome of foals with septic osteitis of the distal phalanx. DESIGN: Retrospective case series. ANIMALS: 22 foals. PROCEDURES: Information obtained from medical records included signalment; clinical, laboratory, and radiographic findings; treatment method; and outcome. Foals included in the study had lameness referable to the foot, radiographic evidence of localized lysis or focal loss of bone density of the distal phalanx, and suppurative discharge or necrosis of the affected bone evident at surgery. Foals with a history or evidence of penetrating wounds or subsolar abscessation were excluded. RESULTS: Mean age of foals at initial evaluation was 40.8 days (range, 3 to 122 days). Twenty-one (95%) foals had lameness as the primary complaint. Lesions consistent with septic osteitis of the distal phalanx localized to specific areas of the bone on the basis of radiographic and surgical findings were located on the solar margin or toe (14/22 [64%]), extensor process (5/22 [23%]), and palmar or plantar process (3/22 [13%]). Hind limbs (18/26 [69%] affected limbs) were more frequently affected. Two foals had > 1 affected limb, 2 had additional sites of osteomyelitis, and 4 had concurrent septic arthritis. Surgical debridement and regional antimicrobial perfusion were performed during general anesthesia. Extensor process lesions were not debrided. Nineteen of 22 (86%) foals survived to be discharged from hospital, and 16 horses reached racing age. Eleven of 16 had race starts, of which 8 had official race starts and 3 had unofficial race starts. CONCLUSIONS AND CLINICAL RELEVANCE: Septic osteitis of the distal phalanx should be considered as a source of lameness in foals with signs referable to the foot and does not necessarily preclude a career in racing. Although infection may occur secondary to bacterial penetration of the hoof or sole, the distal phalanx should also be considered as a potential site for hematogenous septic arthritis or osteomyelitis in foals.     

Genetics of colour traits in common vetch (Vicia sativa L.)

Five parents of common vetch (Vicia sativa L.) having orange/beige cotyledon colour, brown/white testa colour, purple/green seedling colour and purple/white flower colour were crossed as a full diallele set. The inheritance patterns of cotyledon, testa or seed coat colour, flower and seedling colour, were studied by analyzing their F₁, F₂, BC₁ and BC₂ generations. The segregation pattern in F₂, BC₁ and BC₂, showed that cotyledon colour was governed by a single gene with incomplete dominance and it is proposed that cotyledon colour is controlled by two allelic genes, which have been designated Ct₁ and Ct₂. Testa colour was governed by a single gene with the brown allele dominant and the recessive allele white. This gene has been given the symbol H. Two complementary genes governed both flower and seedling colours. These flower and seedling colour genes are pleiotropic and the two genes have been given the symbols S and F.     

Characterization of the major proteins of tubers of yam bean (Pachyrhizus ahipa)

Tubers of six accessions of ahipa (Pachyrhizus ahipa) contained between 0.77 and 1.34% nitrogen on a dry weight basis. This corresponds to 4.8 to 8.4% crude protein based on a nitrogen to protein conversion factor of 6.25; but detailed analysis of AC230 showed that although 93% of the total N was extracted with buffer containing 1.0 M NaCl, about a third of this was lost on dialysis. It was calculated, therefore, that salt-soluble proteins comprise about 60% of the total tuber nitrogen, with low-molecular-mass nitrogenous components comprising a further 30%. Electophoretic analysis of the salt-soluble proteins showed similar patterns of components in the six accessions, with none being present in amounts sufficiently high to suggest a role as storage proteins. Furthermore, light microscopy failed to show significant deposits of protein within the tuber cells. Five "major" protein bands, which together accounted for about 19% of the total salt-soluble protein fraction were purified and subjected to N-terminal amino acid sequencing. Comparison of these with sequences in protein databases revealed similarities to alpha-amylases, chitinases and chitin binding proteins, cysteine proteinases (including major components from P. erosus tubers), a tuberization-specific protein from potato, and proteins induced in soybean and pea by stress or the plant hormone abscisic acid, respectively. It was concluded that the primary roles of these proteins are probably in aspects of tuber metabolism and development and/or conferring protection to pests and pathogens, and that true storage proteins are not present. The absence of storage proteins is consistent with the biological role of the tubers as storage organs for carbohydrates (cf cassava tuberous roots) rather than as propagules (cf yam and potato tubers).