A pilot study evaluating the use of ABCD2 score in pre-hospital assessment of patients with suspected transient ischaemic attack: experience and lessons learned

Background: Suspected transient ischaemic attack (TIA) is a common presentation to emergency medical services (EMS) in the United Kingdom (UK). Several EMS systems have adopted the ABCD2 score to aid pre-hospital risk stratification and decision-making on patient disposition, such as direct referral to an Emergency Department or specialist TIA clinic. However, the ABCD2 score, developed for hospital use, has not been validated for use in the pre-hospital context of EMS care. Methods: We conducted a pilot study to assess eligibility criteria, recruitment rates, protocol compliance, consent and follow-up procedures to inform the development of a definitive study to validate the ABCD2 tool in pre-hospital evaluation of patients with suspected TIA. Results: From 1st May–1st September 2013, nine patients with an EMS suspected diagnosis of TIA had the TIA diagnosis later confirmed by a specialist from five participating sites. This recruitment rate is comparable to stroke trials in the EMS setting. Bureaucratic obstacles and duplication of approval processes across participating sites took 13 months to resolve before recruitment commenced. Due to the initial difficulty in recruitment, a substantial amendment was approved to modify inclusion criteria, allowing patients with atrial fibrillation and/or taking anticoagulant therapy to participate in the study. Conclusions: It is possible to identify, recruit and follow up patients with suspected TIA in the EMS setting. Training large numbers of EMS staff is required as exposure to TIA patients is infrequent. Significant insight was gained into the complexity of NHS research governance mechanisms in the UK. This knowledge will facilitate the planning of a future adequately powered study to validate the ABCD2 tool in a pre-hospital setting

Listeria monocytogenes in Milk Products

peer-reviewedMilk and milk products are frequently identified as vectors for transmission of Listeria monocytogenes. Milk can be contaminated at farm level either by indirect external contamination from the farm environment or less frequently by direct contamination of the milk from infection in the animal. Pasteurisation of milk will kill L. monocytogenes, but post-pasteurisation contamination, consumption of unpasteurised milk and manufacture of unpasteurised milk products can lead to milk being the cause of outbreaks of listeriosis. Therefore, there is a concern that L. monocytogenes in milk could lead to a public health risk. To protect against this risk, there is a need for awareness surrounding the issues, hygienic practices to reduce the risk and adequate sampling and analysis to verify that the risk is controlled. This review will highlight the issues surrounding L. monocytogenes in milk and milk products, including possible control measures. It will therefore create awareness about L. monocytogenes, contributing to protection of public health

The use of bioluminescence to study the behaviour of Listeria monocytogenes when attached to surfaces

A recombinant derivative of Listeria monocytogenes engineered to express the lux AB genes of Vibrio harveyi has a bioluminescent phenotype that provides a rapid monitor of microbial viability. This phenotype was employed to follow bacterial attachment on to stainless steel surfaces, to monitor the growth of microcolonies upon these surfaces and to assess the resistance of the attached cells following biocide challenge. Real-time bioluminescence measurements provided data equivalent to viable count determinations, and the organism was found to become more resistant to the biocide phenol upon attachment to stainless steel surfaces

The antibacterial activity of Virkon measured by colony growth and bioluminescence of lux recombinant Listeria monocytogenes

Concentration exponents for the broad spectrum antimicrobial Virkon were determined for Listeria monocytogenes using both plate counts and bioluminescence measurements; the values of 3.15 and 2.6 indicate a close equivalence between these two measurement procedures. Virkon is an effective biocide for L. monocytogenes at the manufacturer's in-use concentration of 1%

Bioluminescent Listeria monocytogenes provide a rapid assay for measuring biocide efficacy

A recombinant derivative of Listeria monocytogenes 23074, engineered to express the luxAB genes of Vibrio fischeri MJ1, has a bioluminescent phenotype that provides a rapid monitor of microbial viability. The antibacterial activity of phenol and chlorhexidine diacetate (Hibitane) was measured using both bioluminescence and viable counts. Concentration exponents were assessed as 7.3 for phenol and 2.63 for chlorhexidine diacetate using plate counts. The rapidity of bioluminescence measurement constitutes a major advantage in biocide assessment