Infective endocarditis caused by Arcanobacterium haemolyticum: a case report

Arcanobacterium haemolyticum is an organism that commonly causes pharyngitis and wound infections. It does not usually cause systemic invasive disease. The organism presents a difficult diagnostic problem because the Clinical Microbiology laboratory has a propensity to view them as diphtheroid organisms of the Corynebacterium species, thus contaminants or normal flora. We describe a case of a 21-year-old female who had endocarditis with cerebral emboli due to Arcanobacterium haemolyticum. This rare condition is associated with significant mortality and to the best of our knowledge; this is the first successfully treated case of A. haemolyticum endocarditis complicated by embolic phenomenon

“For review and management”: The role of the referral letter in surgical consultations

Background: The referral letter serves a central role in the transfer of patients from referring doctors to specialist care in Australia. Aim: We analysed the form and function of referral letters and examined their role in surgical consultations to better understand the information in the letter and what impact that may or may not have on consultation openings. Methods: Thirteen referral letters and their associated recorded surgical consultations were analysed with an iterative, multi-methods qualitative approach. Using inductive and deductive linguistic methods, we considered clinical and paraclinical information as well as contextual factors in the letters’ alignment with referral guidelines as well as overall relevance to the consultation. Results: The analysis showed that surgeons tend to have a “set piece” when opening a consultation that is independent of the content or style of the referral. While referral letters fell short of guidelines, additional patient information was frequently discussed in the consultation. Discussion: Patients and surgeons are generally able to work around interactional challenges related to patient information. However, recognising the need to supplement referral information particularly around paraclinical information and contextual factors is important. Conclusions: Future changes to referral letter guidelines could reflect these realities

Talking their way to success : communicative competence for international medical graduates in transition

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Developing rapport in inter-professional communication : insights for international medical graduates

Many Western countries including Australia have become reliant on international medical graduates (IMGs) to strengthen their medical workforce. In Australia, the majority of IMGs are now from non-English speaking backgrounds and work in medical and communicative environments in which they were not raised or trained themselves. They therefore face the challenge of understanding unfamiliar hospital systems and guidelines, and a new set of cultural and communicative parameters. In this paper, we report findings from a pilot study investigating the communicative challenges that IMGs face in simulated medical handovers in an Australian hospital context. Using a case study approach and tools from applied linguistics and intercultural pragmatics, we analyse the discourse of two doctors to identify some of the discourse features that native English-speaking and expert medical practitioners use to establish and maintain rapport with colleagues. We draw on the distinction between the pragmalinguistic and sociopragmatic aspects of the inter-professional context to illuminate the different areas of communication that might be tackled explicitly and systematically as part of IMG preparation for practice in Australia. In this way we illustrate how discourse data can contribute to an evidence base from which principled approaches to communication training for IMGs may be developed.13 page(s

Inter-professional clinical handover in surgical practice

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Homozygous loss of ADAM3A revealed by genome-wide analysis of pediatric high-grade glioma and diffuse intrinsic pontine gliomas

Overall, pediatric high-grade glioma (pHGG) has a poor prognosis, in part due to the lack of understanding of the underlying biology. High-resolution 244 K oligo array comparative genomic hybridization (CGH) was used to analyze DNA from 38 formalin-fixed paraffin-embedded predominantly pretreatment pHGG samples, including 13 diffuse intrinsic pontine gliomas (DIPGs). The patterns of gains and losses were distinct from those seen in HGG arising in adults. In particular, we found 1q gain in up to 27% of our cohort compared with 9% reported in adults. A total of 13% had a balanced genetic profile with no large-scale copy number alterations. Homozygous loss at 8p12 was seen in 6 of 38 (16%) cases of pHGG. This novel deletion, which includes the ADAM3A gene, was confirmed by quantitative real-time PCR (qPCR). Loss of CDKN2A/CDKN2B in 4 of 38 (10%) samples by oligo array CGH was confirmed by fluorescent in situ hybridization on tissue microarrays and was restricted to supratentorial tumors. Only ∼50% of supratentorial tumors were positive for CDKN2B expression by immunohistochemistry (IHC), while ∼75% of infratentorial tumors were positive for CDKN2B expression (P = 0.03). Amplification of the 4q11–13 region was detected in 8% of cases and included PDGFRA and KIT, and subsequent qPCR analysis was consistent with the amplification of PDGFRA. MYCN amplification was seen in 5% of samples being significantly associated with anaplastic astrocytomas (P= 0.03). Overall, DIPG shared similar spectrum of changes to supratentorial HGG with some notable differences, including high-frequency loss of 17p and 14q and lack of CDKN2A/CDKN2B deletion. Informative genetic data providing insight into the underlying biology and potential therapeutic possibilities can be generated from archival tissue and typically small biopsies from DIPG. Our findings highlight the importance of obtaining pretreatment samples

Flexible alarm calling in meerkats: the role of the social environment and predation urgency

Flexible vocal production has been demonstrated in several vertebrate species with much work focusing on the role of the social “audience” in explaining variation in call production. It is, however, likely that the decision to call is an emergent property of both external and internal factors and the extent to which these factors are integrated has been little investigated. We addressed this question by examining the production of alarm calls in wild male meerkats (Suricata suricatta) in different social environments and different predator-encounter contexts. Males searching for reproductive opportunities (rovers), were followed: (i) in their home group and when prospecting, either (ii) solitarily, or (iii) in a coalition with other males. Results showed conspecific presence influenced the production of flee-alarm and recruitment calls. Solitary rovers were less likely to produce flee-alarm calls compared to when with conspecifics, whether coalitionary rovers or the rover’s home group. Experimentally elicited recruitment calls were also produced less when males were solitary than when in their home group. Bark vocalisations, emitted when meerkats were safe were always produced, irrespective of conspecific presence, indicating these calls function to address predators. The probability of producing flee-alarms also increased with urgency of the predation event. Our results indicate that variation in alarm call production depends on whom the call is addressed to, and also the motivational state of the caller. We argue that neglecting to integrate internal and external factors when elucidating mechanisms underlying vocal production can potentially lead to misguided, parsimonious conclusions regarding vocal flexibility in animals