Case Organization Research Articles

Effect of antipyretics on performance of influenza surveillance in Ghana.

The World Health Organization's case definition for influenza-like illness (ILI) includes a measured temperature of ≥38°C. We conducted this study to assess the effect of antipyretics on performance of ILI surveillance in Ghana. A cross-sectional study was conducted in two districts of Ghana from September 2013 to May 2014. We collected epidemiological data and respiratory specimens from an expanded ILI case definition, which included patients presenting to health facilities with measured temperature ≥38°C or reported fever (but afebrile at the time of evaluation), and cough, with onset in the last 10days. Specimens were tested for influenza viruses by real time reverse-transcription polymerase chain reaction. Of 321 participants who met our expanded ILI case definition, 236 presented with temperature of <38°C but reported subjective fever. Of these, 17% (39/236) were positive for influenza virus; Of those with fever ≤38°C who took antipyretics, 21%(16/77) were positive for influenza, compared with 14%(23/159) of those who did not take antipyretics. The addition of subjective fever to the standard ILI case definition captured approximately an additional 57% influenza cases but also required testing of approximately four times as many patients. However, including those without fever on presentation that had taken antipyretics found an additional 23% of Influenza cases and only two times as much testing. Depending on the goals of surveillance (monitoring virus circulation or determining disease burden) and available resources, a more sensitive case definition including subjective fever and history of use of antipyretics may be warranted.

Clinical Profile of Neonates Admitted with Sepsis to Neonatal Intensive Care Unit of Jimma Medical Center, A Tertiary Hospital in Ethiopia.

Globally, over 3 million newborn die each year, one million of these attributed to infections. The objective of this study was to determine the etiologies and clinical characteristics of sepsis in neonates admitted to intensive care unit of a tertiary hospital in Ethiopia. A longitudinal hospital based cohort study was conducted from April 1 to October 31, 2018 at the neonatal intensive care unit of Jimma Medical Center, southwest Ethiopia. Diagnosis of sepsis was established using the World Health Organization's case definition. Structured questionnaires and case specific recording formats were used to capture the relevant data. Venous blood and cerebrospinal fluid from neonates suspected to have sepsis were collected. Out of 304 neonates enrolled in the study, 195 (64.1%) had clinical evidence for sepsis, majority (84.1%; 164/195) of them having early onset neonatal sepsis. The three most frequent presenting signs and symptoms were fast breathing (64.6%; 122/195), fever (48.1%; 91/195) and altered feeding (39.0%; 76/195). Etiologic agents were detected from the blood culture of 61.2% (115/195) neonates. Bacterial pathogens contributed for 94.8% (109/115); the rest being fungal etiologies. Coagulase negative staphylococci (25.7%; 28/109), Staphylococcus aureus (22.1%; 24/109) and Klebsiella species (16.5%; 18/109) were the most commonly isolated bacteria. Majority of the neonates had early onset neonatal sepsis. The major etiologies isolated in our study markedly deviate from the usual organisms causing neonatal sepsis. Multicentre study and continuous surveillance are essential to tackle the current challenge to reduce neonatal mortality due to sepsis in Ethiopia.

Postmortem Diagnosis of Dengue as an Epidemiological Surveillance Tool.

Dengue remains a problem in Brazil, and a substantial number of cases that progress to death are not diagnosed by health services. We evaluated the impact of a protocol adopted by the Coroner's Office Rocha Furtado (CO-RF) for the detection of unreported deaths from dengue in Brazil. We evaluated prospectively cases of deaths referred to the CO-RF with suspicion of dengue and those referred with other diagnosis in which the pathologists suspected dengue as the cause of death. Biological material was collected from all bodies autopsied, for which the suspected cause of death was dengue, between January 2011 and December 2012. Of the 214 bodies autopsied, 134 (62.6%) tested positive for dengue; of these cases, 121 were classified as dengue according to the World Health Organization's case definition (1997 or 2009, as appropriate). Thus, CO-RF detected 90 deaths from dengue, which were not suspected during disease progression. This CO-RF protocol, through a combined effort of the surveillance and laboratory teams, increased the detection of fatal dengue cases by 5-fold. This is the largest series of autopsies performed in cases of death related to dengue in the world to date.

Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance.

The 2009 influenza A(H1N1)pdm09 pandemic highlighted the need for improved scientific knowledge to support better pandemic preparedness and seasonal influenza control. The Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance (SHIVERS) project, a 5-year (2012–2016) multiagency and multidisciplinary collaboration, aimed to measure disease burden, epidemiology, aetiology, risk factors, immunology, effectiveness of vaccination and other prevention strategies for influenza and other respiratory infectious diseases of public health importance. Two active, prospective, population-based surveillance systems were established for monitoring influenza and other respiratory pathogens among those hospitalized patients with acute respiratory illness and those enrolled patients seeking consultations at sentinel general practices. In 2015, a sero-epidemiological study will use a sample of patients from the same practices. These data will provide a full picture of the disease burden and risk factors from asymptomatic infections to severe hospitalized disease and deaths and related economic burden. The results during the first 2 years (2012–2013) provided scientific evidence to (a) support a change to NZ's vaccination policy for young children due to high influenza hospitalizations in these children; (b) contribute to the revision of the World Health Organization's case definition for severe acute respiratory illness for global influenza surveillance; and (c) contribute in part to vaccine strain selection using vaccine effectiveness assessment in the prevention of influenza-related consultations and hospitalizations. In summary, SHIVERS provides valuable international platforms for supporting seasonal influenza control and pandemic preparedness, and responding to other emerging/endemic respiratory-related infections.

Table of Contents

Abstract Increase between‐meeting communications Apply the ‘personal touch’ in a busy world Examine the organization's case for giving Diversity leads to better board decisions Make mentoring activities practical Check in with new members to assess comfort level

Private sector hospital response to the 2003 dengue outbreak in the Indian capital metropolis of Delhi

During 2003, the Indian capital metropolis of Delhi was afflicted with an outbreak of dengue. A private-sector tertiary care hospital responded instantly to the sudden influx of 162 patients during an 8-week interval. That was an unusual challenge because, until 1997, the hospital had exclusively managed patients with ophthalmic disorders. Dengue patients received fiscal concessions and several free services. A multidisciplinary cell was commissioned for case management. Apart from a diagnosis of patients with dengue and their clinical management, suspected or confirmed dengue episodes were instantly reported to health authorities. Anti-mosquito measures in the hospital premises including residential areas for the nursing personnel prevented any local virus transmission. The integrated therapeutic and public health response was associated with a 1.23% case fatality rate. The protocol developed during the dengue outbreak would address every locally reportable disease in the future.

Pertussis infection in fully vaccinated children in day-care centers, Israel.

We tested 46 fully vaccinated children in two day-care centers in Israel who were exposed to a fatal case of pertussis infection. Only two of five children who tested positive for Bordetella pertussis met the World Health Organization's case definition for pertussis. Vaccinated children may be asymptomatic reservoirs for infection.

ESTABLISHING A CASE TOOLBOX

Methodology-intensive technologies are closely tied to an organization's approach to systems development. A CASE tool set should provide the most cost-effective automated solution for the organization's systems development process. This article offers advice on how the IS staff can achieve success with CASE by first defining the organization's CASE environment then following a 15-step process to select tools that enhance the phases of its particular life cycle. A detailed matrix to evaluate multiple vendors' products as they apply to the organization's requirements is included.

Avoiding the Tragedy of Whistleblowing

Most discussions of whistleblowing seek to justify whistleblowing or to distinguish justified from unjustified whistleblowing; or they report who blows the whistle, how, and why; or they advise on how to blow the whistle or how to respond to an employee about to blow the whistle or what to do once she has; or they make recommendations for new laws to protect whistleblowers. In one way or another, they treat whistleblowing as inevitable. I shall not do that. Instead, I shall try to help individuals and organizations avoid whistleblowing. That purpose may suggest that I oppose whistleblowing. I do not. I think whistleblowing is, on balance, at least a necessary evil (and sometimes even a good thing). I certainly think whistleblowers should have legal protection.1 They should not be fired for their good deed or punished for it in any other way. But I doubt that much can be done to protect them. I shall use much of this paper to explain why. That explanation will bring out the destructive side of whistleblowing, making it easier for most of us to see ourselves in the role of those who mistreat whistleblowers. Insofar as it does that, it will give the organization's case for mistreatment. The explanation will, however, also show the importance of avoiding whistleblowing. We should try to get the benefits of whistleblowing without making people and organizations pay the enormous price whistleblowing typically exacts.2